Healthcare Provider Details

I. General information

NPI: 1710028170
Provider Name (Legal Business Name): MACOMB COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 10/02/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46360 GRATIOT AVE
CHESTERFIELD MI
48051-2800
US

IV. Provider business mailing address

46360 GRATIOT AVE
CHESTERFIELD MI
48051-2800
US

V. Phone/Fax

Practice location:
  • Phone: 586-948-0224
  • Fax: 586-948-0213
Mailing address:
  • Phone: 586-948-0224
  • Fax: 586-948-0213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number6301010681
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number6401006960
License Number StateMI

VIII. Authorized Official

Name: MRS. VIRGINIA HELEN ADAMS
Title or Position: THERAPIST III SUPERVISOR
Credential: MA, LLP, LPC, NCC
Phone: 586-948-0224