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1174601512

NPI Code Detail

MEDICARE: ARBOR CIRCLE CORPORATION

MEDICARE: ARBOR CIRCLE CORPORATION

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	103TA0400X	Addiction (Substance Use Disorder) Psychologist
4	103TC2200X	Clinical Child & Adolescent Psychologist
5	106H00000X	Marriage & Family Therapist
6	2084P0800X	Psychiatry Physician
7	207RA0401X	Addiction Medicine (Internal Medicine) Physician	4301034105	MI
8	363A00000X	Physician Assistant	5601003749	MI
9	2080P0006X	Developmental - Behavioral Pediatrics Physician	4301069203	MI
10	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1174601512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARBOR CIRCLE CORPORATION

Provider Business Mailing Address
First Line	:	1115 BALL AVE NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-5904
Country	:	US
Telephone Number	:	616-456-7775
Fax Number	:	616-456-8568

Provider Business Practice Location Address
First Line	:	1115 BALL AVE NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-5904
Country	:	US
Telephone Number	:	616-456-7775
Fax Number	:	616-456-8568

Authorized Official
Title or Position	:	HUMAN RESOURCES MANAGER
Name	:	CATHY CARDOSA
Credential	:
Telephone Number	:	616-456-7775

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	01/04/2023

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Directions to “ARBOR CIRCLE CORPORATION ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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