Healthcare Provider Details

I. General information

NPI: 1124385794
Provider Name (Legal Business Name): DEBRA KAY ALDERTON PATTULLO POINTES NORTH COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 W MILLER RD MCOG BLDG
MIO MI
48647-9735
US

IV. Provider business mailing address

831 W MILLER RD MCOG BLDG
MIO MI
48647-9735
US

V. Phone/Fax

Practice location:
  • Phone: 989-745-2531
  • Fax:
Mailing address:
  • Phone: 989-745-2531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801071700
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401007327
License Number StateMI

VIII. Authorized Official

Name: DEBRA K PATTULLO
Title or Position: OWNER
Credential: LPC
Phone: 989-745-2531