Healthcare Provider Details

I. General information

NPI: 1518141357
Provider Name (Legal Business Name): AMDG SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1853 136TH AVE
DORR MI
49323-9553
US

IV. Provider business mailing address

1853 136TH AVE
DORR MI
49323-9553
US

V. Phone/Fax

Practice location:
  • Phone: 269-793-7672
  • Fax:
Mailing address:
  • Phone: 269-793-7672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID C HANLEY
Title or Position: PRESIDENT
Credential: LMSW
Phone: 269-793-7672