Healthcare Provider Details

I. General information

NPI: 1548323660
Provider Name (Legal Business Name): JEROME NORBERT NADOLSKI LMSW LMFT CEAP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15565 NORTHLAND DR SUITE 505W
SOUTHFIELD MI
48075
US

IV. Provider business mailing address

15565 NORTHLAND DR SUITE 505W
SOUTHFIELD MI
48075
US

V. Phone/Fax

Practice location:
  • Phone: 248-483-3100
  • Fax: 248-483-3104
Mailing address:
  • Phone: 248-483-3100
  • Fax: 248-483-3104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberL870334
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: