MEDICARE: METROPOLITAN COUNSELING CENTER, LLC

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	251S00000X	Community/Behavioral Health Agency	822395	MI

General Provider Information

NPI Number	:	1881728947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METROPOLITAN COUNSELING CENTER, LLC

Provider Business Mailing Address
First Line	:	1415 TRUMBULL ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48216-1368
Country	:	US
Telephone Number	:	313-964-2030
Fax Number	:	313-964-2092

Provider Business Practice Location Address
First Line	:	1415 TRUMBULL ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48216-1368
Country	:	US
Telephone Number	:	313-964-2030
Fax Number	:	313-964-2092

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MICHAEL EDWAED JOHNSON
Credential	:	MSW,LMSW
Telephone Number	:	313-964-2030

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	08/22/2020

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