Doctor Name: | MS. ELLEN LORD |
NPI Number: | 1598973182 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN,MA,CAC-R,CCM |
License Number: | 200695 |
Business Practice Address: | 1005 May St Ste A Charlevoix, MI - 497209380 |
Business Phone Number: | 2318837738 |
Business Fax Number: | 2315887030 |
Mailing Address: | Po Box 61, 1005 May Street, Suite A CHARLEVOIX |
State: | MI |
Postal Code: | 497200061 |
Phone Number: | 2318837738 |
Fax Number: | 2315887030 |
NPI Enumeration Date: | 05/18/2007 |
NPI Last Update Date: | 11/09/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 200695 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |