Healthcare Provider Details

I. General information

NPI: 1215510516
Provider Name (Legal Business Name): UNITE UP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 04/30/2024
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 COLLEGE AVE
HOUGHTON MI
49931-1823
US

IV. Provider business mailing address

1014 COLLEGE AVE
HOUGHTON MI
49931-1823
US

V. Phone/Fax

Practice location:
  • Phone: 906-523-7064
  • Fax:
Mailing address:
  • Phone: 906-523-7064
  • Fax: 904-592-5291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANGELA PRICE
Title or Position: PRESIDENT
Credential:
Phone: 906-523-7064