Healthcare Provider Details

I. General information

NPI: 1083736953
Provider Name (Legal Business Name): THE GUIDANCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13101 ALLEN RD. STE. 100
SOUTHGATE MI
48195
US

IV. Provider business mailing address

1022 CHEROKEE
ROYAL OAK MI
48067
US

V. Phone/Fax

Practice location:
  • Phone: 734-785-7701
  • Fax:
Mailing address:
  • Phone: 248-544-3627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number6301012671
License Number StateMI

VIII. Authorized Official

Name: SUSAN M CLARK
Title or Position: THERAPIST
Credential: MA LLP
Phone: 734-785-7701