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General NPI Number Information
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NPI Number | 1093188948
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Entity Type | Organization
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Legal Business Name | MARYANNE MCLEOD LMSW COUNSELING, LLC
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Dates
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Enumeration Date | 11/01/2015
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Last Update Date | 11/01/2015
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Provider Practice Location Address
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Address Line | 1010 MINNESOTA AVE SUITE 210
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City | GLADSTONE
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State | MI
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Zip | 49837-1502
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Country | US
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Telephone | 906-280-8496
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Fax |
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Provider Business Mailing Address
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Address Line | 1202 MINNESOTA AVE
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City | GLADSTONE
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State | MI
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Zip | 49837-1404
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Country | US
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Telephone | 906-280-8496
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | MS. MARYANNE WOJDA MCLEOD
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Credential | MSW, LMSW, ACSW
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Telephone | 906-290-8496
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801046359
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License Number State | MI
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