Healthcare Provider Details

I. General information

NPI: 1578000998
Provider Name (Legal Business Name): INSIGHT CENTER FOR CREATIVE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2017
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17340 W 12 MILE RD SUITE 202
SOUTHFIELD MI
48076-2122
US

IV. Provider business mailing address

25602 W 12 MILE RD APT. 103
SOUTHFIELD MI
48034-8039
US

V. Phone/Fax

Practice location:
  • Phone: 734-489-3043
  • Fax:
Mailing address:
  • Phone: 734-489-3043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: BRANDI S BUTLER
Title or Position: OWNER, CLINICAL THERAPIST
Credential: LMSW, LCSW
Phone: 734-489-3043