Provider Demographics
NPI:1316980873
Name:FAIRCHILD, MARGARET ADELINE (MSW, CSW)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:ADELINE
Last Name:FAIRCHILD
Suffix:
Gender:F
Credentials:MSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221 1 MILE RD
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MI
Mailing Address - Zip Code:49052-9602
Mailing Address - Country:US
Mailing Address - Phone:269-729-4422
Mailing Address - Fax:269-729-4472
Practice Address - Street 1:2221 1 MILE RD
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MI
Practice Address - Zip Code:49052-9602
Practice Address - Country:US
Practice Address - Phone:269-729-4422
Practice Address - Fax:269-729-4472
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010699281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP20060001Medicare ID - Type Unspecified