Healthcare Provider Details
I. General information
NPI: 1679863856
Provider Name (Legal Business Name): MCCAIN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 04/09/2011
Last Update Date: 04/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2141 E JEFFERSON AVE STE LL1
DETROIT MI
48207-4128
US
IV. Provider business mailing address
2141 E JEFFERSON AVE STE LL1
DETROIT MI
48207-4128
US
V. Phone/Fax
- Phone: 313-952-1963
- Fax: 313-331-9566
- Phone: 313-952-1963
- Fax: 313-331-9566
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YM0800X |
| Taxonomy | Mental Health Counselor |
| License Number | 6401002550 |
| License Number State | MI |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YP2500X |
| Taxonomy | Professional Counselor |
| License Number | 6401002550 |
| License Number State | MI |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 102L00000X |
| Taxonomy | Psychoanalyst |
| License Number | 6301008988 |
| License Number State | MI |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103T00000X |
| Taxonomy | Psychologist |
| License Number | 6301008988 |
| License Number State | MI |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TA0400X |
| Taxonomy | Addiction (Substance Use Disorder) Psychologist |
| License Number | 6301008988 |
| License Number State | MI |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TA0700X |
| Taxonomy | Adult Development & Aging Psychologist |
| License Number | 6301008988 |
| License Number State | MI |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TC1900X |
| Taxonomy | Counseling Psychologist |
| License Number | 6301008988 |
| License Number State | MI |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TC2200X |
| Taxonomy | Clinical Child & Adolescent Psychologist |
| License Number | 6401002550 |
| License Number State | MI |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TF0000X |
| Taxonomy | Family Psychologist |
| License Number | 6301008988 |
| License Number State | MI |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TF0200X |
| Taxonomy | Forensic Psychologist |
| License Number | 6301008988 |
| License Number State | MI |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TH0100X |
| Taxonomy | Health Service Psychologist |
| License Number | 6301008988 |
| License Number State | MI |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TM1800X |
| Taxonomy | Intellectual & Developmental Disabilities Psychologist |
| License Number | 6301008988 |
| License Number State | MI |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TP0814X |
| Taxonomy | Psychoanalysis Psychologist |
| License Number | 6301008988 |
| License Number State | MI |
| # 14 | |
| Primary Taxonomy | N |
| Taxonomy Code | 106H00000X |
| Taxonomy | Marriage & Family Therapist |
| License Number | 6301008988 |
| License Number State | MI |
| # 15 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 103TC0700X |
| Taxonomy | Clinical Psychologist |
| License Number | 6301008988 |
| License Number State | MI |
VIII. Authorized Official
Name: DR.
ANNETTE
MCCAIN
Title or Position: PRESIDENT/CEO
Credential: PHD, LPC, MA, LLP
Phone: 313-952-1963
