Healthcare Provider Details

I. General information

NPI: 1396349932
Provider Name (Legal Business Name): DE MARILLAC COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2020
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37772 CHARTER OAKS BLVD
CLINTON TWP MI
48036-4435
US

IV. Provider business mailing address

37772 CHARTER OAKS BLVD
CLINTON TWP MI
48036-4435
US

V. Phone/Fax

Practice location:
  • Phone: 734-674-4772
  • Fax: 586-948-8758
Mailing address:
  • Phone: 734-674-4772
  • Fax: 586-948-8758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. AMY LEIGH PERUGI
Title or Position: PRESIDENT AND THERAPIST
Credential: LMSW CAADC
Phone: 734-674-4772