Making a Difference Support Services, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSWS1053 Issued in AK

Legal business name

MAKING A DIFFERENCE SUPPORT SERVICES, LLC

Practice address

1867 Airport Way Ste 200
Fairbanks, AK 99701-4061

Phone

(907) 750-7169

Fax

(907) 490-4469

NPI assigned

Jan 9, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Crystal Devon McCormickNPI 1790029114

Title

Owner

Phone

(907) 750-7169

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AK

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Crystal Devon McCormick, LCSW

  • Professional Counselor
  • Fairbanks, AK
  • NPI 1790029114
  Medicare reassignment NPD Authorized official
• Geoffry McCormick

  • Clinical Social Worker
  • Fairbanks, AK
  • NPI 1629770813
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1515456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522800000000",
    "number": "1013424225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1867 AIRPORT WAY STE 200",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997014061",
            "telephone_number": "907-750-7169",
            "fax_number": "907-490-4469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1867 AIRPORT WAY STE 200",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997014061",
            "telephone_number": "907-750-7169",
            "fax_number": "907-490-4469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAKING A DIFFERENCE SUPPORT SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-09",
        "last_updated": "2018-04-04",
        "status": "A",
        "authorized_official_last_name": "MCCORMICK",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_middle_name": "DEVON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "907-750-7169"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "AK",
            "license": "CSWS1053",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Allison Majors
• Nathen Majors
• Rene Majors
• Stephanie Majors
• Making a Difference Support Services
• Liza Sarah Malamute, RN, CDE, CFCN
• Jedidiah Jonah Malan, MD
• Sara DB Malenfant, LMT
• Alejandrina Maria Mallet, RBT
• Kathryn Chatterton Mallory, LPS

• Clinical Social Worker in Fairbanks, AK
• Providers in Fairbanks, AK by specialty
• Clinical Social Worker in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.