Healthcare Provider Details

I. General information

NPI: 1629105937
Provider Name (Legal Business Name): ADOLPH CWIK MA, CRC, CCM, LBSW,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7757 FERRY RD
EAST JORDAN MI
49727-9545
US

IV. Provider business mailing address

PO BOX 665
BOYNE CITY MI
49712-0665
US

V. Phone/Fax

Practice location:
  • Phone: 231-582-2293
  • Fax: 231-582-2293
Mailing address:
  • Phone: 231-582-2293
  • Fax: 231-582-2293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number713
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number#713
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number713
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number13889
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number13760
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: