Healthcare Provider Details

I. General information

NPI: 1285117093
Provider Name (Legal Business Name): CHARIS COUNSELING SERVICES OF NORTHEAST MICHIGAN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2018
Last Update Date: 09/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 N 2ND AVE
ALPENA MI
49707-2805
US

IV. Provider business mailing address

PO BOX 586
ALPENA MI
49707-0586
US

V. Phone/Fax

Practice location:
  • Phone: 989-340-1466
  • Fax: 989-538-8790
Mailing address:
  • Phone: 989-340-1466
  • Fax: 989-538-8790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: RACHEL ACHATZ
Title or Position: PRACTICE DIRECTOR
Credential: LPC
Phone: 989-340-1466