Provider Demographics
NPI:1164943353
Name:FAMILY SUPPORTIVE SERVICES OF NORTHERN MICHIGAN LLC
Entity Type:Organization
Organization Name:FAMILY SUPPORTIVE SERVICES OF NORTHERN MICHIGAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LLMSW
Authorized Official - Phone:231-878-8189
Mailing Address - Street 1:121 N MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-1879
Mailing Address - Country:US
Mailing Address - Phone:231-878-8189
Mailing Address - Fax:517-323-9531
Practice Address - Street 1:121 N MITCHELL ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-1879
Practice Address - Country:US
Practice Address - Phone:231-878-8189
Practice Address - Fax:517-323-9531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010950511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty