Provider Demographics
NPI:1356829501
Name:CROMWELL, CHRISTINE (MSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:CROMWELL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:KOEHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2354 S GRAY RD
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-9606
Mailing Address - Country:US
Mailing Address - Phone:989-390-9797
Mailing Address - Fax:
Practice Address - Street 1:2354 S GRAY RD
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-9606
Practice Address - Country:US
Practice Address - Phone:989-362-8636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68020707071041C0700X
MI68011110121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical