| Provider / Organization | NPI | Date Certified |
|---|---|---|
| MICHAEL ACOSTA | 1508460460 | 2020-11-22 |
| Entity Type | Individual |
| Provider Name | Michael Acosta LMSW |
| Practice Office Address | 1011 LAKE RIDGE DR UNIT 305 TRAVERSE CITY, MI US |
| Practice Office Telephone | 2315900048 |
| Mailing Address | 1011 LAKE RIDGE DR UNIT 305 TRAVERSE CITY, MI 496846625 US |
| Business Telephone | 2315900048 |
| Code | License No | State |
|---|---|---|
| 1041C0700X PRIMARY | 6801064319 | MI |