Provider Demographics
NPI:1629105937
Name:CWIK, ADOLPH W (MA, CRC, CCM, LBSW,)
Entity Type:Individual
Prefix:MR
First Name:ADOLPH
Middle Name:W
Last Name:CWIK
Suffix:
Gender:M
Credentials:MA, CRC, CCM, LBSW,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 665
Mailing Address - Street 2:
Mailing Address - City:BOYNE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49712-0665
Mailing Address - Country:US
Mailing Address - Phone:231-582-2293
Mailing Address - Fax:231-582-2293
Practice Address - Street 1:7757 FERRY RD
Practice Address - Street 2:
Practice Address - City:EAST JORDAN
Practice Address - State:MI
Practice Address - Zip Code:49727-9545
Practice Address - Country:US
Practice Address - Phone:231-582-2293
Practice Address - Fax:231-582-2293
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI713101YM0800X, 1041S0200X
MI#713101YP2500X
MI13889106H00000X
MI13760171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator