Healthcare Provider Details

I. General information

NPI: 1508325200
Provider Name (Legal Business Name): SUSAN M CARD LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 03/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 GILBERT ST
FLINT MI
48532-3527
US

IV. Provider business mailing address

5050 PIERSONVILLE RD
COLUMBIAVILLE MI
48421-9343
US

V. Phone/Fax

Practice location:
  • Phone: 810-422-9406
  • Fax: 810-733-7623
Mailing address:
  • Phone: 810-793-1784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801064007
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: