Healthcare Provider Details

I. General information

NPI: 1124439104
Provider Name (Legal Business Name): CHRISTINE SZOSTAK LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 09/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 ELDON BAKER DR HOPE NETWORK
FLINT MI
48507-1923
US

IV. Provider business mailing address

1110 ELDON BAKER DR HOPE NETWORK
FLINT MI
48507-1923
US

V. Phone/Fax

Practice location:
  • Phone: 810-213-1803
  • Fax:
Mailing address:
  • Phone: 810-213-1803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801093076
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: