Healthcare Provider Details

I. General information

NPI: 1396034922
Provider Name (Legal Business Name): CLINICAL COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 06/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11340 MARION
REDFORD MI
48239-2017
US

IV. Provider business mailing address

11340 MARION
REDFORD MI
48239-2017
US

V. Phone/Fax

Practice location:
  • Phone: 248-777-0008
  • Fax:
Mailing address:
  • Phone: 248-561-2747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801083836
License Number StateMI

VIII. Authorized Official

Name: MS. SHANNON L KROPP
Title or Position: BILLING MANAGER
Credential: CPC
Phone: 734-402-7384