MEDICARE: MS. RITA KINSTLE MA, LLPC, CAC-M

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	1-04117	MI
2	101YP2500X	Professional Counselor	6401012582	MI
3	101YM0800X	Mental Health Counselor	6401012582	MI

General Provider Information

NPI Number	:	1437373552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RITA KINSTLE MA, LLPC, CAC-M

Provider Business Mailing Address
First Line	:	31153 PLYMOUTH RD
Second Line	:	SUITE 104
City	:	LIVONIA
State	:	MI
Zip	:	48150-2134
Country	:	US
Telephone Number	:	734-474-8131
Fax Number	:

Provider Business Practice Location Address
First Line	:	31153 PLYMOUTH RD
Second Line	:	SUITE 104
City	:	LIVONIA
State	:	MI
Zip	:	48150-2134
Country	:	US
Telephone Number	:	734-474-8131
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	06/12/2014

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