Healthcare Provider Details

I. General information

NPI: 1295916187
Provider Name (Legal Business Name): FAMILY THERAPY & DEVELOPMENT CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 04/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 LAKESHORE DR
SAINT JOSEPH MI
49085-1874
US

IV. Provider business mailing address

4384 LAUREL DRIVE
ST JOSEPH MI
49085
US

V. Phone/Fax

Practice location:
  • Phone: 269-982-3832
  • Fax: 269-281-0351
Mailing address:
  • Phone: 269-982-3832
  • Fax: 269-281-0351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6801087845
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number6802080845
License Number StateMI

VIII. Authorized Official

Name: MS. JANENE MARIE DONARSKI
Title or Position: OWNER AND THERAPIST
Credential: PHD, MSW
Phone: 269-982-3832