Healthcare Provider Details

I. General information

NPI: 1497830202
Provider Name (Legal Business Name): JUDITH LYNN CHURCH LMSW, ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 TUURI PL
FLINT MI
48503-2465
US

IV. Provider business mailing address

2465 PEBBLE RIDGE CT
DAVISON MI
48423-8621
US

V. Phone/Fax

Practice location:
  • Phone: 810-767-5750
  • Fax:
Mailing address:
  • Phone: 810-658-2432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801080784
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: