Provider Demographics
NPI:1710674403
Name:MCDONALD, AMBER MARIE
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MARIE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9117 GRAND BLANC RD
Mailing Address - Street 2:
Mailing Address - City:GAINES
Mailing Address - State:MI
Mailing Address - Zip Code:48436-9663
Mailing Address - Country:US
Mailing Address - Phone:810-962-2086
Mailing Address - Fax:
Practice Address - Street 1:9117 GRAND BLANC RD
Practice Address - Street 2:
Practice Address - City:GAINES
Practice Address - State:MI
Practice Address - Zip Code:48436-9663
Practice Address - Country:US
Practice Address - Phone:810-962-2086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI22161040601104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker