Provider Demographics
NPI:1174656292
Name:MARESH, COLLEEN J (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:J
Last Name:MARESH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:JOY
Other - Last Name:RYCHLEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:209 1ST ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2102
Mailing Address - Country:US
Mailing Address - Phone:517-998-4673
Mailing Address - Fax:
Practice Address - Street 1:209 1ST ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2102
Practice Address - Country:US
Practice Address - Phone:517-998-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011020771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical