Provider Demographics
NPI:1891853883
Name:HERRICK, CHRISTIE DENISE (LMSW, ACSW)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:DENISE
Last Name:HERRICK
Suffix:
Gender:F
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3630 E SAGINAW HWY
Mailing Address - Street 2:
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837-8434
Mailing Address - Country:US
Mailing Address - Phone:517-627-5442
Mailing Address - Fax:517-627-5442
Practice Address - Street 1:3630 E SAGINAW HWY
Practice Address - Street 2:
Practice Address - City:GRAND LEDGE
Practice Address - State:MI
Practice Address - Zip Code:48837-8434
Practice Address - Country:US
Practice Address - Phone:517-627-5442
Practice Address - Fax:517-627-5442
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010701111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical