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General NPI Number Information
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NPI Number | 1316328289
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Entity Type | Organization
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Legal Business Name | FOWLERVILLE COUNSELING CENTER
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Dates
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Enumeration Date | 06/16/2015
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Last Update Date | 06/16/2015
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Provider Practice Location Address
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Address Line | 202 E VAN RIPER RD SUITE 100
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City | FOWLERVILLE
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State | MI
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Zip | 48836-7947
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Country | US
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Telephone | 517-575-8842
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Fax |
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Provider Business Mailing Address
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Address Line | 202 E VAN RIPER RD SUITE 100
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City | FOWLERVILLE
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State | MI
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Zip | 48836-7947
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Country | US
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Telephone | 517-575-8842
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHERIE DEE WILCOX
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Credential | LLP
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Telephone | 517-575-8842
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301008689
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License Number State | MI
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