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General NPI Number Information
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NPI Number | 1851853907
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Entity Type | Organization
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Legal Business Name | ACG THERAPY SERVICES
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Dates
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Enumeration Date | 04/05/2019
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Last Update Date | 01/10/2020
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Provider Practice Location Address
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Address Line | 11831 MAPLE RD STE 4
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City | BIRCH RUN
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State | MI
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Zip | 48415-8487
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Country | US
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Telephone | 248-408-6478
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Fax |
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Provider Business Mailing Address
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Address Line | 1871 E PACKARD DR
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City | SAGINAW
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State | MI
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Zip | 48638-4516
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Country | US
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Telephone | 248-408-6478
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Fax |
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Authorized Official
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Title or Position | CLINICAL MASTER SOCIAL WORK
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Name | ANGELA GAUTHIER
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Credential | LMSW
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Telephone | 248-408-6478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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