Provider Demographics
NPI:1922282359
Name:NORTHERN CLINICAL AND DIAGNOSTIC ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:NORTHERN CLINICAL AND DIAGNOSTIC ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:R
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:231-845-2900
Mailing Address - Street 1:101 S JAMES ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-2166
Mailing Address - Country:US
Mailing Address - Phone:231-845-2900
Mailing Address - Fax:231-845-2905
Practice Address - Street 1:101 S JAMES ST
Practice Address - Street 2:SUITE 215
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-2166
Practice Address - Country:US
Practice Address - Phone:231-845-2900
Practice Address - Fax:231-845-2905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301001424103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1821144015OtherINDIVIDUAL NPI NUMBER
MI68-0-E3-4503-0OtherBC/BS
1821144015OtherINDIVIDUAL NPI NUMBER