Provider Demographics
NPI:1386820504
Name:MCGIVERN, MICHELLE (MSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MCGIVERN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N WEST AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-2179
Mailing Address - Country:US
Mailing Address - Phone:517-789-1234
Mailing Address - Fax:517-784-7040
Practice Address - Street 1:25 CARE DR
Practice Address - Street 2:SUITE 231
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-5054
Practice Address - Country:US
Practice Address - Phone:517-439-2609
Practice Address - Fax:517-439-2667
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010841981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical