Doctor Name: | MRS. COURTNEY RENEE EVENINGRED |
NPI Number: | 1639400351 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LLMSW |
License Number: | 6801091817 |
Business Practice Address: | 1322 N River Rd Saint Clair, MI - 480792803 |
Business Phone Number: | 8103294798 |
Business Fax Number: | 8103297303 |
Mailing Address: | 1322 N River Rd, SAINT CLAIR |
State: | MI |
Postal Code: | 480792803 |
Phone Number: | 8103294798 |
Fax Number: | 8103297303 |
NPI Enumeration Date: | 01/20/2010 |
NPI Last Update Date: | 01/20/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 6801091817 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |