Provider Demographics
NPI:1700177227
Name:A NEW HOPE COUNSELING CENTER
Entity Type:Organization
Organization Name:A NEW HOPE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRUSTEE
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:FANDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:517-323-4531
Mailing Address - Street 1:3815 W ST JOE ST STE A400
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-5600
Mailing Address - Country:US
Mailing Address - Phone:517-323-4531
Mailing Address - Fax:517-323-4531
Practice Address - Street 1:3815 W ST JOE ST STE A400
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-5600
Practice Address - Country:US
Practice Address - Phone:517-323-4531
Practice Address - Fax:517-323-4531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-02
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI630-100-8822103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
68-0-C34663-0OtherCOMMUNITY BLUE
MIOC-34663OtherBC/BS
MI262-068-000OtherMAGELLAN
MIP26624FOtherBLUE CARE NETWORK