MEDICARE: JANICE ADRIA EICKHOLT-MARCH LMSW

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	2-01369	MI
2	1041C0700X	Clinical Social Worker	6801104034	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2-01369	OTHER	MI	CERTIFIED DRUG AND ALCOHOL COUNSELOR

General Provider Information

NPI Number	:	1326418534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE ADRIA EICKHOLT-MARCH LMSW

Provider Business Mailing Address
First Line	:	19507 BISHOP RD
Second Line	:
City	:	NEW LOTHROP
State	:	MI
Zip	:	48460-9630
Country	:	US
Telephone Number	:	810-818-7584
Fax Number	:	810-228-7586

Provider Business Practice Location Address
First Line	:	19507 BISHOP RD
Second Line	:
City	:	NEW LOTHROP
State	:	MI
Zip	:	48460-9630
Country	:	US
Telephone Number	:	989-818-7584
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2015
Last Update Date	:	06/21/2023

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