Provider Demographics
NPI:1770741308
Name:RANKIN, MARK ERIC (LMSW, ACSW)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ERIC
Last Name:RANKIN
Suffix:
Gender:M
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2344 WINDY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-1474
Mailing Address - Country:US
Mailing Address - Phone:231-737-6469
Mailing Address - Fax:
Practice Address - Street 1:1435 PECK ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-2125
Practice Address - Country:US
Practice Address - Phone:231-733-5334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801085548172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker