Healthcare Provider Details

I. General information

NPI: 1811921901
Provider Name (Legal Business Name): DENNIS DRAKE ROZEMA LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 04/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N OLD WOODWARD AVE SUITE 304
BIRMINGHAM MI
48009-1324
US

IV. Provider business mailing address

1609 KILBURN RD N
ROCHESTER HILLS MI
48306-3028
US

V. Phone/Fax

Practice location:
  • Phone: 248-561-5054
  • Fax:
Mailing address:
  • Phone: 248-561-5054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6401002426
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401002426
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401002426
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number6401002426
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: