Healthcare Provider Details

I. General information

NPI: 1619411212
Provider Name (Legal Business Name): CHRELLE LOONSFOOT LLBSW, CPRC, CPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2016
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 W BRISTOL RD
FLINT MI
48507-5516
US

IV. Provider business mailing address

1402 S SAGINAW ST
FLINT MI
48503-3705
US

V. Phone/Fax

Practice location:
  • Phone: 810-257-3736
  • Fax:
Mailing address:
  • Phone: 810-493-1906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6852094128
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: