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NPI Code Detail

MEDICARE: CHRIS PAHOLAK CADC

MEDICARE:   CHRIS  PAHOLAK  CADC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor2-01692MI

General Provider Information

NPI Number : 1063171346
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRIS PAHOLAK CADC
Provider Business Mailing Address
First Line : PO BOX 179
Second Line :
City : CHIPPEWA LAKE
State : MI
Zip : 49320-0179
Country : US
Telephone Number : 231-580-6355
Fax Number :
Provider Business Practice Location Address
First Line : 18554 NORTHLAND DR
Second Line :
City : BIG RAPIDS
State : MI
Zip : 49307-8788
Country : US
Telephone Number : 231-580-6355
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2021
Last Update Date : 12/14/2021

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Directions to “ CHRIS PAHOLAK CADC” Practice Location

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