Provider Demographics
NPI:1831309392
Name:FERENC, THALIA MARIE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:THALIA
Middle Name:MARIE
Last Name:FERENC
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 1:6127 BAY SHORE WEST DR
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-9173
Mailing Address - Country:US
Mailing Address - Phone:231-838-2322
Mailing Address - Fax:231-622-8126
Practice Address - Street 1:6127 BAY SHORE WEST DR
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-9173
Practice Address - Country:US
Practice Address - Phone:231-838-2322
Practice Address - Fax:231-622-8126
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2019-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010597451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11573200OtherCAQH