Provider Demographics
NPI:1932632965
Name:CORE, DAVID MATTHEW (DP-C)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:MATTHEW
Last Name:CORE
Suffix:
Gender:M
Credentials:DP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3190 HALLMARK CT
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2100
Mailing Address - Country:US
Mailing Address - Phone:989-790-3366
Mailing Address - Fax:989-790-5027
Practice Address - Street 1:6840 MIDLAND RD
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:MI
Practice Address - Zip Code:48623-8708
Practice Address - Country:US
Practice Address - Phone:989-790-3366
Practice Address - Fax:989-790-5027
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)