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General NPI Number Information
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NPI Number | 1528166204
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Entity Type | Organization
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Legal Business Name | CHILDREN'S ASSESSMENT CENTER
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 12125 UNION ST
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City | HOLLAND
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State | MI
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Zip | 49424-8603
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Country | US
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Telephone | 616-393-6123
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Fax | 616-393-0918
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Provider Business Mailing Address
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Address Line | 12125 UNION ST
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City | HOLLAND
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State | MI
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Zip | 49424-8603
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Country | US
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Telephone | 616-393-6123
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Fax | 616-393-0918
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MISS DARCY KOMEJAN
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Credential | M.D.MSW
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Telephone | 616-393-6123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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