Provider Demographics
NPI:1659775807
Name:FAIRMAN, TRINA (BSW, LLBSW, CDP)
Entity Type:Individual
Prefix:
First Name:TRINA
Middle Name:
Last Name:FAIRMAN
Suffix:
Gender:F
Credentials:BSW, LLBSW, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 312
Mailing Address - Street 2:1375 R. DALE WERTZ DR.
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413
Mailing Address - Country:US
Mailing Address - Phone:989-269-9293
Mailing Address - Fax:989-269-7544
Practice Address - Street 1:1375 R. DALE WERTZ DR.
Practice Address - Street 2:
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413
Practice Address - Country:US
Practice Address - Phone:989-269-9293
Practice Address - Fax:989-269-7544
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011070801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical