Provider Demographics
NPI:1538432174
Name:PERRY, MARC W (MA, CAADC, ICAADC)
Entity type:Individual
Prefix:MR
First Name:MARC
Middle Name:W
Last Name:PERRY
Suffix:
Gender:M
Credentials:MA, CAADC, ICAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 148
Mailing Address - Street 2:
Mailing Address - City:LAINGSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48848
Mailing Address - Country:US
Mailing Address - Phone:517-648-1644
Mailing Address - Fax:
Practice Address - Street 1:120 W. EXCHANGE STREET, SUITE 300
Practice Address - Street 2:CATHOLIC CHARITIES
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867
Practice Address - Country:US
Practice Address - Phone:989-723-8239
Practice Address - Fax:989-723-8230
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC00013101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor