Healthcare Provider Details

I. General information

NPI: 1447885447
Provider Name (Legal Business Name): PAWSITIVE COUNSELING CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 S STEWART AVE
FREMONT MI
49412-1624
US

IV. Provider business mailing address

106 S STEWART AVE
FREMONT MI
49412-1624
US

V. Phone/Fax

Practice location:
  • Phone: 231-923-8568
  • Fax: 231-722-3018
Mailing address:
  • Phone: 231-923-8568
  • Fax: 231-722-3018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MARY J THOMPSON-ROTTIER
Title or Position: OWNER
Credential:
Phone: 231-923-8568