Provider Demographics
NPI:1154612299
Name:CHAMPINE, ANDREW (PSYD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:CHAMPINE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 S MACKINAW RD
Mailing Address - Street 2:
Mailing Address - City:KAWKAWLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48631-9117
Mailing Address - Country:US
Mailing Address - Phone:989-450-5496
Mailing Address - Fax:
Practice Address - Street 1:G3230 BEECHER RD STE 1
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3604
Practice Address - Country:US
Practice Address - Phone:810-342-5620
Practice Address - Fax:810-342-5629
Is Sole Proprietor?:No
Enumeration Date:2011-04-24
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016072103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist