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General NPI Number Information
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NPI Number | 1265911945
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Entity Type | Organization
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Legal Business Name | ANNE KRCATOVICH, MA, LLP, LLC
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Dates
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Enumeration Date | 08/13/2018
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Last Update Date | 08/13/2018
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Provider Practice Location Address
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Address Line | 164 N MAIN ST
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City | PLYMOUTH
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State | MI
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Zip | 48170-1236
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Country | US
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Telephone | 734-578-1605
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Fax | 734-453-3310
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Provider Business Mailing Address
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Address Line | 164 N MAIN ST
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City | PLYMOUTH
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State | MI
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Zip | 48170-1236
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Country | US
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Telephone | 734-578-1605
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Fax | 734-453-3310
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Authorized Official
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Title or Position | OWNER
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Name | ANNE THERESE KRCATOVICH
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Credential | MA, LLP
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Telephone | 734-578-1605
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 6301016045
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License Number State | MI
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