Provider Demographics
NPI:1225817349
Name:PRINCE, MICHAEL GENE (PEER SUPPORT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GENE
Last Name:PRINCE
Suffix:
Gender:M
Credentials:PEER SUPPORT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 MUSKINGUM AVE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-4957
Mailing Address - Country:US
Mailing Address - Phone:740-255-2217
Mailing Address - Fax:
Practice Address - Street 1:217 MUSKINGUM AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-4957
Practice Address - Country:US
Practice Address - Phone:740-255-2217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-27
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist