Healthcare Provider Details

I. General information

NPI: 1427346170
Provider Name (Legal Business Name): C.W. ENTERPRISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2011
Last Update Date: 03/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32743 23 MILE RD STE 130
CHESTERFIELD MI
48047-2082
US

IV. Provider business mailing address

32743 23 MILE RD STE 130
CHESTERFIELD MI
48047-2082
US

V. Phone/Fax

Practice location:
  • Phone: 586-273-7095
  • Fax: 586-273-7196
Mailing address:
  • Phone: 586-273-7095
  • Fax: 586-273-7196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. YOLANDA J DOBBYN
Title or Position: OFFICE MANAGER
Credential:
Phone: 586-273-7095