Healthcare Provider Details

I. General information

NPI: 1053663633
Provider Name (Legal Business Name): HANDS ACROSS THE WATER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2012
Last Update Date: 10/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

781 AVIS DR STE 200
ANN ARBOR MI
48108-8959
US

IV. Provider business mailing address

781 AVIS DR STE 200
ANN ARBOR MI
48108-8959
US

V. Phone/Fax

Practice location:
  • Phone: 734-477-0135
  • Fax: 734-477-0213
Mailing address:
  • Phone: 734-477-0135
  • Fax: 734-477-0213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberCB810201161
License Number StateMI
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberCB810201161
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License NumberCB810201161
License Number StateMI

VIII. Authorized Official

Name: AMY BETH FRY
Title or Position: BEHAVIORAL HEALTH SPECIALIST
Credential:
Phone: 734-477-0135