Healthcare Provider Details

I. General information

NPI: 1750107181
Provider Name (Legal Business Name): RACHEL RITA PIZZURRO LMSW, CCM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 W HURON ST STE 107
PONTIAC MI
48341-1601
US

IV. Provider business mailing address

54689 GEMINI DR
SHELBY TOWNSHIP MI
48316-1628
US

V. Phone/Fax

Practice location:
  • Phone: 248-724-7600
  • Fax:
Mailing address:
  • Phone: 248-990-4643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6801061934
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: