Provider Demographics
NPI:1063171346
Name:PAHOLAK, CHRIS (CADC)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:PAHOLAK
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 179
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49320-0179
Mailing Address - Country:US
Mailing Address - Phone:231-580-6355
Mailing Address - Fax:
Practice Address - Street 1:18554 NORTHLAND DR
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-8788
Practice Address - Country:US
Practice Address - Phone:231-580-6355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2-01692101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty