Provider Demographics
NPI:1205850914
Name:MCCRANDALL, JANICE ANN (MA, LLP, LPC)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:ANN
Last Name:MCCRANDALL
Suffix:
Gender:F
Credentials:MA, LLP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7489 TROUTWOOD DR APT 1A
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-7503
Mailing Address - Country:US
Mailing Address - Phone:810-730-9661
Mailing Address - Fax:248-922-2304
Practice Address - Street 1:6770 DIXIE HWY STE 312
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2090
Practice Address - Country:US
Practice Address - Phone:248-922-2300
Practice Address - Fax:248-922-2304
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007219101YM0800X
MI6301010964103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist