Most Relevant Information
Provider Data
| NPI Number: | 1003686304 |
| Provider Name: | GERAMIE MARK MCCORMICK CRM II, CADC-R |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: | T-23-2430 |
Most Important Dates
| Enumeration Date: | 01/08/2024 |
| Last Updated: | 01/08/2024 |
Provider Practice Location
91150 N COBURG INDUSTRIAL WAY
COBURG
OR
974089512
Practice Location Phone/Fax
| Phone: | 5412845645 |
| Fax: |
Provider Mailing Location
91150 N COBURG INDUSTRIAL WAY
COBURG
OR
974089512
Provider Mailing Phone/Fax
| Phone: | 5416066281 |
| Fax: |