Healthcare Provider Details

I. General information

NPI: 1992732176
Provider Name (Legal Business Name): KATHERINE RHEAUME BAXTER LMSW, CAADC, CCDP-D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS KATHERINE ANNE RHEAUME

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W 5TH AVE
FLINT MI
48503-2445
US

IV. Provider business mailing address

5054 PIERSONVILLE RD
COLUMBIAVILLE MI
48421-9343
US

V. Phone/Fax

Practice location:
  • Phone: 810-496-4910
  • Fax: 810-496-4922
Mailing address:
  • Phone: 810-793-6794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801067089
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC-00472
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: