Provider Demographics
NPI:1437278249
Name:DELTA-WAVERLY PSYCHOLOGY AND COUNSELING ASSOCIATES, PLC
Entity Type:Organization
Organization Name:DELTA-WAVERLY PSYCHOLOGY AND COUNSELING ASSOCIATES, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:WHITING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-323-4099
Mailing Address - Street 1:701 S CREYTS RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-8234
Mailing Address - Country:US
Mailing Address - Phone:517-323-4099
Mailing Address - Fax:
Practice Address - Street 1:701 S CREYTS RD
Practice Address - Street 2:SUITE C
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-8234
Practice Address - Country:US
Practice Address - Phone:517-323-4099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty