| NPI | 1134649981 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNA DEETTE VAN WYCK Counselor 231-329-4262 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401013905) |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2022-07-21 |