Healthcare Provider Details

I. General information

NPI: 1083389928
Provider Name (Legal Business Name): MR. CHARLES EDWARD LAYMOND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30671 STEPHENSON HWY STE C
MADISON HEIGHTS MI
48071-1635
US

IV. Provider business mailing address

6675 LAKEVIEW BLVD APT 6316
WESTLAND MI
48185-5826
US

V. Phone/Fax

Practice location:
  • Phone: 248-850-1600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801119694
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: