Healthcare Provider Details

I. General information

NPI: 1669353884
Provider Name (Legal Business Name): MARLENE DIANE BIVINS-ISERI LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N MITCHELL ST STE 204
CADILLAC MI
49601-1859
US

IV. Provider business mailing address

201 N MITCHELL ST STE 204
CADILLAC MI
49601-1859
US

V. Phone/Fax

Practice location:
  • Phone: 231-538-7341
  • Fax:
Mailing address:
  • Phone: 231-538-7341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451025030
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451025030
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: