Provider Demographics
NPI:1114668134
Name:GARCHOW, MARLA DIANE (DCP)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:DIANE
Last Name:GARCHOW
Suffix:
Gender:F
Credentials:DCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 CARLISLE RD
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49696-9156
Mailing Address - Country:US
Mailing Address - Phone:231-342-4878
Mailing Address - Fax:231-421-3275
Practice Address - Street 1:1855 CARLISLE RD
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49696-9156
Practice Address - Country:US
Practice Address - Phone:231-342-4878
Practice Address - Fax:231-421-3275
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS280406473253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency