MEDICARE: A CENTER FOR COUNSELING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6801071699	MI

General Provider Information

NPI Number	:	1154562775
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A CENTER FOR COUNSELING, LLC

Provider Business Mailing Address
First Line	:	2427 SPRING ARBOR RD STE 1AND2
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-2988
Country	:	US
Telephone Number	:	517-474-4673
Fax Number	:

Provider Business Practice Location Address
First Line	:	2427 SPRING ARBOR RD STE 1AND2
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-2988
Country	:	US
Telephone Number	:	517-474-4673
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL SOCIAL WORKER, THERAPIST
Name	:	MRS. CATHERINE LOUISE HARDWICK
Credential	:	ACSW, LMSW
Telephone Number	:	517-474-4673

Provider Enumeration Date	:	03/11/2009
Last Update Date	:	03/11/2009

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