Provider Demographics
NPI:1487881199
Name:CRAIN, AUDETTE MARIE (MALLPC)
Entity type:Individual
Prefix:MRS
First Name:AUDETTE
Middle Name:MARIE
Last Name:CRAIN
Suffix:
Gender:F
Credentials:MALLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 COURT ST N
Mailing Address - Street 2:
Mailing Address - City:STANDISH
Mailing Address - State:MI
Mailing Address - Zip Code:48658-9417
Mailing Address - Country:US
Mailing Address - Phone:989-718-2041
Mailing Address - Fax:
Practice Address - Street 1:365 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:MI
Practice Address - Zip Code:48659-9577
Practice Address - Country:US
Practice Address - Phone:989-751-2442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-20
Last Update Date:2009-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1545769101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor