Basic Information
| Provider Information | |||||||||
| NPI: | 1457824328 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BERNADINE PICKETT, PLLC | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 63401 DEQUINDRE ROAD | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480952203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487524881 | ||||||||
| FaxNumber: | 9999999999 | ||||||||
| Practice Location | |||||||||
| Address1: | 63401 DEQUINDRE ROAD | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480952203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487524881 | ||||||||
| FaxNumber: | 9999999999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2019 | ||||||||
| LastUpdateDate: | 01/03/2019 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PICKETT | ||||||||
| AuthorizedOfficialFirstName: | BERNADINE | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | LICENSED PROFESSIONAL COUNSELOR | ||||||||
| AuthorizedOfficialTelephone: | 2487524881 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | MA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.