Provider Demographics
NPI:1861516031
Name:FAMILY SERVICE AGENCY OF MID-MICHIGAN
Entity type:Organization
Organization Name:FAMILY SERVICE AGENCY OF MID-MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:P
Authorized Official - Last Name:TOMMASULO
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, BCD, LMFT
Authorized Official - Phone:810-767-4014
Mailing Address - Street 1:1422 W COURT ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-5008
Mailing Address - Country:US
Mailing Address - Phone:810-767-4014
Mailing Address - Fax:810-767-0020
Practice Address - Street 1:1422 W COURT ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-5008
Practice Address - Country:US
Practice Address - Phone:810-767-4014
Practice Address - Fax:810-767-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health