Healthcare Provider Details

I. General information

NPI: 1316174550
Provider Name (Legal Business Name): DARLENE R MASSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 06/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 LAFAYETTE ST
PONTIAC MI
48342-2033
US

IV. Provider business mailing address

13087 E 11 MILE RD SUITE 200
WARREN MI
48088-4795
US

V. Phone/Fax

Practice location:
  • Phone: 248-338-7458
  • Fax: 248-338-7513
Mailing address:
  • Phone: 586-754-3060
  • Fax: 586-754-4010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401006899
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: