Provider Demographics
NPI:1184162216
Name:LONTSCHARITSCH, DORIS
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:
Last Name:LONTSCHARITSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 E GRAND RIVER AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-2478
Mailing Address - Country:US
Mailing Address - Phone:517-545-5944
Mailing Address - Fax:517-545-7390
Practice Address - Street 1:2020 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-2478
Practice Address - Country:US
Practice Address - Phone:517-545-5944
Practice Address - Fax:517-545-7390
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801099271104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker