Healthcare Provider Details

I. General information

NPI: 1467628768
Provider Name (Legal Business Name): CHARLES JAMES SNYDER LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2312 MONROE ST
DEARBORN MI
48124-3010
US

IV. Provider business mailing address

2312 MONROE ST
DEARBORN MI
48124-3010
US

V. Phone/Fax

Practice location:
  • Phone: 313-561-1098
  • Fax: 313-561-0709
Mailing address:
  • Phone: 313-561-1098
  • Fax: 313-561-0709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6801067143
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: