Provider Demographics
NPI:1679098248
Name:TICE, CHRISTIE A (BACHELOR IN SCIENCE)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:A
Last Name:TICE
Suffix:
Gender:F
Credentials:BACHELOR IN SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2028 LEIF AVE
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441
Mailing Address - Country:US
Mailing Address - Phone:616-456-8010
Mailing Address - Fax:
Practice Address - Street 1:2028 LEIF AVE
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441-3650
Practice Address - Country:US
Practice Address - Phone:616-456-8010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI01OtherOTHER
MI05Medicaid