Healthcare Provider Details

I. General information

NPI: 1881027225
Provider Name (Legal Business Name): MR. WADE GARVINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2013
Last Update Date: 08/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2617 BERKLEY ST
FLINT MI
48504-3373
US

IV. Provider business mailing address

2617 BERKLEY ST
FLINT MI
48504-3373
US

V. Phone/Fax

Practice location:
  • Phone: 810-308-5818
  • Fax: 810-232-7919
Mailing address:
  • Phone: 810-308-5818
  • Fax: 810-232-7919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: