Provider Demographics
NPI:1053475319
Name:FARISON, NANCY SUZAN (LMSW ACSW)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:SUZAN
Last Name:FARISON
Suffix:
Gender:F
Credentials:LMSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2549 E FREELAND RD
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:MI
Mailing Address - Zip Code:48623-9420
Mailing Address - Country:US
Mailing Address - Phone:989-430-0608
Mailing Address - Fax:
Practice Address - Street 1:314 W WACKERLY ST
Practice Address - Street 2:SUITE C
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-2766
Practice Address - Country:US
Practice Address - Phone:989-832-1978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical