| On Hold | |
|
205 N East Ave Jackson MI 49201-1753 | |
| (517) 788-4800 | |
| Not Available |
| Full Name | On Hold |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 205 N East Ave, Jackson, Michigan |
| Authorized Official Name and Position | Mark Smith (SVP. CMO) |
| Authorized Official Contact | 5172056407 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| On Hold Po Box 67000 Department 272801 Detroit MI 48267-2728 Ph: (571) 841-6913 | On Hold 205 N East Ave Jackson MI 49201-1753 Ph: (517) 788-4800 |
| NPI Number | 1134335581 |
|---|---|
| Provider Enumeration Date | 05/15/2007 |
| Last Update Date | 03/06/2024 |
| Certification Date | 03/06/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134335581 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (Michigan) | Secondary |
| 104100000X | Social Worker | (Michigan) | Secondary |
| 1041C0700X | Social Worker - Clinical | (Michigan) | Primary |
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