Little House On Mackinaw, LLC

NPI #1639831993 in Bay City, Michigan

Provider Information

NPI Number: 1639831993
Entity Type: Organization
Organization Name: Little House On Mackinaw, LLC
Primary Specialty: Social Worker - Clinical
Enumeration Date: Oct 13, 2021
Last Updated: Oct 13, 2021

Practice Location

Address: 6988 MACKINAW RD
City: Bay City
State: Michigan
ZIP Code: 48706-9332
Phone: (989) 790-2005

Authorized Official

Name: DIANE KUKULIS, LMSW
Title: SOLE MEMBER
Phone: (989) 790-2005

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Social Worker - Clinical — Clinical	1041C0700X	Primary

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