Healthcare Provider Details

I. General information

NPI: 1144494006
Provider Name (Legal Business Name): MARCELLA MAREA PAYNE-CHARLEY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22151 MOROSS RD PB1, STE. 334
DETROIT MI
48236-2167
US

IV. Provider business mailing address

22151 MOROSS RD PB1, STE. 334
DETROIT MI
48236-2167
US

V. Phone/Fax

Practice location:
  • Phone: 313-343-7230
  • Fax:
Mailing address:
  • Phone: 313-343-7230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401009381
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: