Healthcare Provider Details

I. General information

NPI: 1679871073
Provider Name (Legal Business Name): PATRICIA ANN KEARNEY LPC,LLP,CAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2011
Last Update Date: 03/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8097 DECATUR ST
DETROIT MI
48228-2721
US

IV. Provider business mailing address

8097 DECATUR ST
DETROIT MI
48228-2721
US

V. Phone/Fax

Practice location:
  • Phone: 313-846-5020
  • Fax: 313-846-3468
Mailing address:
  • Phone: 313-846-5020
  • Fax: 313-846-3468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401007603
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301011435
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: