Healthcare Provider Details

I. General information

NPI: 1629118815
Provider Name (Legal Business Name): CAROL SEACORD LMSW,ACSW,BCD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 12/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 ADA DR SE SUITE 103
ADA MI
49301-9024
US

IV. Provider business mailing address

PO BOX 554
ADA MI
49301-0554
US

V. Phone/Fax

Practice location:
  • Phone: 616-676-4003
  • Fax: 616-676-4403
Mailing address:
  • Phone: 616-676-4003
  • Fax: 616-676-4403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801018566
License Number StateMI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: