Healthcare Provider Details

I. General information

NPI: 1255009528
Provider Name (Legal Business Name): ANDREA MORGAN KISS CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 BEAUBIEN ST
DETROIT MI
48201-2166
US

IV. Provider business mailing address

3950 BEAUBIEN ST
DETROIT MI
48201-2166
US

V. Phone/Fax

Practice location:
  • Phone: 313-832-9330
  • Fax: 313-993-8685
Mailing address:
  • Phone: 313-832-9330
  • Fax: 313-993-8685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number3126323
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number7201000209
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: