Provider Demographics
NPI:1790211456
Name:BEAUCHAMP, JANICE (LBSW, CADC)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:BEAUCHAMP
Suffix:
Gender:F
Credentials:LBSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ISHPEMING
Mailing Address - State:MI
Mailing Address - Zip Code:49849-2168
Mailing Address - Country:US
Mailing Address - Phone:906-789-3528
Mailing Address - Fax:906-786-9801
Practice Address - Street 1:2500 7TH AVE S
Practice Address - Street 2:SUITE 202
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-1176
Practice Address - Country:US
Practice Address - Phone:906-789-3528
Practice Address - Fax:906-786-9801
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2-01314101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)