Provider Demographics
NPI:1760977227
Name:CONKLIN, CONSTANCE C (LMSW)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:C
Last Name:CONKLIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 E GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-2329
Mailing Address - Country:US
Mailing Address - Phone:517-546-4126
Mailing Address - Fax:517-552-2526
Practice Address - Street 1:622 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-2329
Practice Address - Country:US
Practice Address - Phone:517-546-4126
Practice Address - Fax:517-552-2526
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010604971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical