Provider Demographics
NPI:1154424455
Name:ZEMENS, GERALD CHARLES
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:CHARLES
Last Name:ZEMENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S MAIN ST
Mailing Address - Street 2:PO BOX 678
Mailing Address - City:ALMONT
Mailing Address - State:MI
Mailing Address - Zip Code:48003-1073
Mailing Address - Country:US
Mailing Address - Phone:810-441-5396
Mailing Address - Fax:810-798-3561
Practice Address - Street 1:400 STODDARD ROAD
Practice Address - Street 2:BOX 41038
Practice Address - City:MEMPHIS
Practice Address - State:MI
Practice Address - Zip Code:48041
Practice Address - Country:US
Practice Address - Phone:810-392-2167
Practice Address - Fax:810-392-3530
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI500044101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)