Healthcare Provider Details

I. General information

NPI: 1831782861
Provider Name (Legal Business Name): COMPASSIONATE CARE COUNSELING AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2021
Last Update Date: 02/20/2021
Certification Date: 02/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30153 SHOREHAM ST
SOUTHFIELD MI
48076-5366
US

IV. Provider business mailing address

30153 SHOREHAM ST
SOUTHFIELD MI
48076-5366
US

V. Phone/Fax

Practice location:
  • Phone: 248-506-2287
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MARKIE SILVERMAN
Title or Position: OWNER
Credential:
Phone: 248-506-2287