Provider Demographics
NPI:1821477845
Name:THE MEN'S COUNSELING CENTER OF NORTHERN MICHIGAN, LLC
Entity Type:Organization
Organization Name:THE MEN'S COUNSELING CENTER OF NORTHERN MICHIGAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:DONALDSON
Authorized Official - Suffix:
Authorized Official - Credentials:LLP
Authorized Official - Phone:231-487-0025
Mailing Address - Street 1:2202 MITCHELL PARK DR
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8897
Mailing Address - Country:US
Mailing Address - Phone:231-487-0025
Mailing Address - Fax:231-487-1754
Practice Address - Street 1:2202 MITCHELL PARK DR
Practice Address - Street 2:SUITE 2B
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8897
Practice Address - Country:US
Practice Address - Phone:231-487-0025
Practice Address - Fax:231-487-1754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009941251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health