Provider Demographics
NPI:1710324827
Name:MARSH-MCCREADIE, DAWN MARIE (LBSW)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:MARIE
Last Name:MARSH-MCCREADIE
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4616 E WACKERLY RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-9301
Mailing Address - Country:US
Mailing Address - Phone:989-600-6989
Mailing Address - Fax:
Practice Address - Street 1:4616 E WACKERLY RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-9301
Practice Address - Country:US
Practice Address - Phone:989-600-6989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802077370104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker