Provider Demographics
NPI:1134193204
Name:MCCORMICK, GAIL L (LMSW)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:L
Last Name:MCCORMICK
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:PO BOX 274
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49410-0274
Mailing Address - Country:US
Mailing Address - Phone:231-462-3684
Mailing Address - Fax:
Practice Address - Street 1:395 3RD ST
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-1718
Practice Address - Country:US
Practice Address - Phone:231-309-1811
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010681321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIGM068132Other3RD PARTY IDENTIFIERS
MI6801068132OtherSTATE LICENSE NUMBER
MI6801068132OtherSTATE LICENSE NUMBER