Healthcare Provider Details

I. General information

NPI: 1023569571
Provider Name (Legal Business Name): MR. MARK ANTHONY DENNING JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4814 TRESSA DR
LANSING MI
48910-5106
US

IV. Provider business mailing address

4814 TRESSA DR
LANSING MI
48910-5106
US

V. Phone/Fax

Practice location:
  • Phone: 517-862-4693
  • Fax:
Mailing address:
  • Phone: 517-862-4693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401015605
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: