Healthcare Provider Details

I. General information

NPI: 1457787640
Provider Name (Legal Business Name): FAMILY CHOICE COUNSELING AND CASE MANAGEMENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2013
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 N ELMS RD SUITE G
FLUSHING MI
48433-1871
US

IV. Provider business mailing address

3280 N ELMS RD SUITE G
FLUSHING MI
48433-1871
US

V. Phone/Fax

Practice location:
  • Phone: 810-835-8093
  • Fax:
Mailing address:
  • Phone: 810-835-8093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801087394
License Number StateMI

VIII. Authorized Official

Name: KAREN MARIE FORD
Title or Position: CLINICAL THERAPIST
Credential: LMSW
Phone: 810-835-8093