Provider Demographics
NPI:1922405430
Name:ADVANTGAE COUNSELING AND EDUCATIONAL
Entity Type:Organization
Organization Name:ADVANTGAE COUNSELING AND EDUCATIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-679-0200
Mailing Address - Street 1:81 N HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:CROSWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48422-1222
Mailing Address - Country:US
Mailing Address - Phone:810-679-0200
Mailing Address - Fax:
Practice Address - Street 1:81 N HOWARD AVE
Practice Address - Street 2:
Practice Address - City:CROSWELL
Practice Address - State:MI
Practice Address - Zip Code:48422-1222
Practice Address - Country:US
Practice Address - Phone:810-679-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011000101YP2500X
MI68010837481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty