Healthcare Provider Details

I. General information

NPI: 1912298910
Provider Name (Legal Business Name): GARY JOSEPH ZILLI MA GUIDANCE & COUNSE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2011
Last Update Date: 04/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20811 KELLY ROAD SUITE 103
EASTPOINTE MI
48021
US

IV. Provider business mailing address

29567 EIFFEL
WARREN MI
48088
US

V. Phone/Fax

Practice location:
  • Phone: 586-445-2210
  • Fax:
Mailing address:
  • Phone: 586-573-7828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC-00924
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: