Healthcare Provider Details

I. General information

NPI: 1104448570
Provider Name (Legal Business Name): CALLY LILLY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2020
Last Update Date: 05/08/2020
Certification Date: 05/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24519 OLDE ORCHARD ST
NOVI MI
48375-2977
US

IV. Provider business mailing address

24519 OLDE ORCHARD ST
NOVI MI
48375-2977
US

V. Phone/Fax

Practice location:
  • Phone: 313-300-1357
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY Z BROWN
Title or Position: OWNER
Credential: LPC,LBSW
Phone: 313-300-1357