Healthcare Provider Details

I. General information

NPI: 1720672413
Provider Name (Legal Business Name): CENTER FOR THERAPEUTIC ARTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 08/02/2022
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

376 HILTON RD APT B
FERNDALE MI
48220-2956
US

IV. Provider business mailing address

2425 DALLAS AVE
ROYAL OAK MI
48067-3584
US

V. Phone/Fax

Practice location:
  • Phone: 248-200-9962
  • Fax:
Mailing address:
  • Phone: 248-200-9962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. CARISSA PINTAR
Title or Position: OWNER/DIRECTOR
Credential: PSYD, LPC, ATR
Phone: 248-200-9962