Healthcare Provider Details

I. General information

NPI: 1538295514
Provider Name (Legal Business Name): KIMBERLY MARIE MCCREA LMSW, ACSW, DCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5331 PLYMOUTH RD
ANN ARBOR MI
48105-9520
US

IV. Provider business mailing address

47103 WATERS EDGE LN B217
BELLEVILLE MI
48111-3180
US

V. Phone/Fax

Practice location:
  • Phone: 734-996-9111
  • Fax:
Mailing address:
  • Phone: 734-775-3451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801058560
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: