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General NPI Number Information
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NPI Number | 1922389477
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Entity Type | Organization
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Legal Business Name | GRAND BLANC THERAPY
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Dates
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Enumeration Date | 08/29/2011
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Last Update Date | 08/29/2011
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Provider Practice Location Address
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Address Line | 8323 OFFICE PARK DR SUITE B
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City | GRAND BLANC
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State | MI
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Zip | 48439-2068
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Country | US
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Telephone | 810-659-7242
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Fax | 810-953-3116
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Provider Business Mailing Address
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Address Line | 8323 OFFICE PARK DR SUITE B
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City | GRAND BLANC
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State | MI
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Zip | 48439-2068
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Country | US
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Telephone | 810-659-7242
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Fax | 810-953-3116
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Authorized Official
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Title or Position | OWNER
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Name | YVONNE MAKIDON
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Credential |
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Telephone | 810-659-7242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801085260
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License Number State | MI
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