Healthcare Provider Details

I. General information

NPI: 1003723941
Provider Name (Legal Business Name): MARY EVELYN HOPKINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36400 WOODWARD AVE STE 222
BLOOMFIELD HILLS MI
48304-0913
US

IV. Provider business mailing address

4871 STURTEVANT ST
DETROIT MI
48204-1474
US

V. Phone/Fax

Practice location:
  • Phone: 248-629-2799
  • Fax:
Mailing address:
  • Phone: 267-822-2232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451025160
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: