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General NPI Number Information
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NPI Number | 1700177227
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Entity Type | Organization
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Legal Business Name | A NEW HOPE COUNSELING CENTER
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Dates
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Enumeration Date | 05/02/2011
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Last Update Date | 12/12/2017
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Provider Practice Location Address
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Address Line | 3815 W ST JOE ST STE A400
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City | LANSING
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State | MI
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Zip | 48917-5600
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Country | US
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Telephone | 517-323-4531
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Fax | 517-323-4531
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Provider Business Mailing Address
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Address Line | 3815 W ST JOE ST STE A400
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City | LANSING
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State | MI
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Zip | 48917-5600
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Country | US
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Telephone | 517-323-4531
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Fax | 517-323-4531
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Authorized Official
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Title or Position | TRUSTEE
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Name | DR. RONALD D FANDRICK
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Credential | PH.D.
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Telephone | 517-323-4531
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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 | 630-100-8822
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License Number State | MI
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