Provider Demographics
NPI:1104583350
Name:WEAVER, AMY (MS)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4273 CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-5321
Mailing Address - Country:US
Mailing Address - Phone:989-953-4357
Mailing Address - Fax:
Practice Address - Street 1:4273 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-5321
Practice Address - Country:US
Practice Address - Phone:989-953-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4610OtherAMY WEAVER
MI0369OtherINDIVIDUAL