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General NPI Number Information
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NPI Number | 1821147638
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Entity Type | Organization
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Legal Business Name | MARJORIE A SOPER P.C.
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 04/22/2008
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Provider Practice Location Address
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Address Line | 12751 S SAGINAW ST STE 700
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City | GRAND BLANC
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State | MI
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Zip | 48439-2751
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Country | US
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Telephone | 810-579-5757
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Fax | 810-579-5757
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Provider Business Mailing Address
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Address Line | 4465 ATLAS RD
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City | DAVISON
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State | MI
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Zip | 48423-8707
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Country | US
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Telephone | 810-579-5757
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Fax | 810-579-5757
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Authorized Official
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Title or Position | THERAPIST
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Name | MRS. MARJORIE A SOPER
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Credential | LMSW, CSW
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Telephone | 810-579-5757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801063883
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License Number State | MI
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