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General NPI Number Information
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NPI Number | 1922282359
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Entity Type | Organization
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Legal Business Name | NORTHERN CLINICAL AND DIAGNOSTIC ASSOCIATES, PLLC
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Dates
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Enumeration Date | 12/20/2007
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Last Update Date | 04/21/2008
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Provider Practice Location Address
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Address Line | 101 S JAMES ST SUITE 215
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City | LUDINGTON
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State | MI
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Zip | 49431-2166
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Country | US
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Telephone | 231-845-2900
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Fax | 231-845-2905
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Provider Business Mailing Address
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Address Line | 101 S JAMES ST SUITE 215
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City | LUDINGTON
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State | MI
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Zip | 49431-2166
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Country | US
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Telephone | 231-845-2900
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Fax | 231-845-2905
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. ERIC R. HARVEY
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Credential | PH.D.
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Telephone | 231-845-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301001424
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License Number State | MI
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