Provider Demographics
NPI:1649635087
Name:CODDAIRE & ASSOCIATES, INC.
Entity type:Organization
Organization Name:CODDAIRE & ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATELYN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CODDAIRE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LLP, LPC
Authorized Official - Phone:616-706-8334
Mailing Address - Street 1:6445 CITATION DR STE H
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2996
Mailing Address - Country:US
Mailing Address - Phone:616-706-8334
Mailing Address - Fax:
Practice Address - Street 1:6445 CITATION DRIVE, SUITE H
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346
Practice Address - Country:US
Practice Address - Phone:616-706-8334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014746251S00000X
MI6301015429251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health