Provider Demographics
NPI:1184998171
Name:MAYWARD, BARBARA ANN (LPC, CCS, CAADC)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:MAYWARD
Suffix:
Gender:F
Credentials:LPC, CCS, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1956 BOSTON ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-4169
Mailing Address - Country:US
Mailing Address - Phone:616-776-0891
Mailing Address - Fax:616-243-9854
Practice Address - Street 1:1956 BOSTON ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506
Practice Address - Country:US
Practice Address - Phone:616-776-0891
Practice Address - Fax:616-243-9854
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010152101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6401010152OtherMICHIGAN LICENSE LPC
MIS20108OtherMICHIGAN CERTIFICATION BOARD FOR ADDICTION PROFESSIONALS CCS
MIC00736OtherMICHIGAN CERTIFICATION BOARD FOR ADDICTION PROFESSIONALS CAADC