Healthcare Provider Details

I. General information

NPI: 1962015081
Provider Name (Legal Business Name): CHRISTIAN PERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 01/11/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15600 19 MILE RD
CLINTON TOWNSHIP MI
48038-3502
US

IV. Provider business mailing address

15600 19 MILE RD
CLINTON TOWNSHIP MI
48038-3502
US

V. Phone/Fax

Practice location:
  • Phone: 586-263-8735
  • Fax: 586-412-7889
Mailing address:
  • Phone: 586-263-8735
  • Fax: 586-412-7889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6852093117
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: