Healthcare Provider Details

I. General information

NPI: 1114039856
Provider Name (Legal Business Name): CENTER FOR EFFECTIVE LIVING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 05/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42657 GARFIELD RD STE 213
CLINTON TWP MI
48038
US

IV. Provider business mailing address

42657 GARFIELD RD STE 213
CLINTON TWP MI
48044
US

V. Phone/Fax

Practice location:
  • Phone: 586-228-8838
  • Fax: 586-228-0813
Mailing address:
  • Phone: 586-228-8838
  • Fax: 586-228-0813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801035885
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4101005701
License Number State

VIII. Authorized Official

Name: MS. LINDA ROSE CLOR
Title or Position: CLINICAL SOCIAL WORKER
Credential: MSW LMFT
Phone: 586-228-8838