MEDICARE: ABALONE COUNSELING

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1407311723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABALONE COUNSELING

Provider Business Mailing Address
First Line	:	11678 OLIVE LAKE DR
Second Line	:
City	:	WEST OLIVE
State	:	MI
Zip	:	49460
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17194 VAN WAGONER RD
Second Line	:
City	:	SPRING LAKE
State	:	MI
Zip	:	49456-9793
Country	:	US
Telephone Number	:	616-846-1053
Fax Number	:	616-846-1129

Authorized Official
Title or Position	:	LPC
Name	:	DOROTHY D. CALDWELL
Credential	:	MA
Telephone Number	:	810-577-9987

Provider Enumeration Date	:	02/01/2019
Last Update Date	:	02/01/2019

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