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General NPI Number Information
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NPI Number | 1114744802
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Entity Type | Individual
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Provider Name | CHARLES JACOB HUITEMA
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Gender | Male
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Dates
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Enumeration Date | 09/24/2024
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Last Update Date | 09/24/2024
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Provider Practice Location Address
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Address Line | 829 W MAIN ST STE C3
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City | GAYLORD
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State | MI
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Zip | 49735-1998
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Country | US
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Telephone | 989-732-6761
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Fax |
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Provider Business Mailing Address
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Address Line | 1181 NUS23
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City | EAST TAWAS
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State | MI
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Zip | 48730
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Country | US
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Telephone | 989-260-2903
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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