Provider Demographics
NPI:1629118815
Name:SEACORD, CAROL (LMSW,ACSW,BCD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:SEACORD
Suffix:
Gender:F
Credentials:LMSW,ACSW,BCD
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 554
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-0554
Mailing Address - Country:US
Mailing Address - Phone:616-676-4003
Mailing Address - Fax:616-676-4403
Practice Address - Street 1:519 ADA DR SE
Practice Address - Street 2:SUITE 103
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-9024
Practice Address - Country:US
Practice Address - Phone:616-676-4003
Practice Address - Fax:616-676-4403
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010185661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI2465Medicare PIN