Healthcare Provider Details

I. General information

NPI: 1922051416
Provider Name (Legal Business Name): METRO FAMILY SUPPORT COUNSELING PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39393 VAN DYKE STE 209,
STERLING HTS MI
48313-4637
US

IV. Provider business mailing address

39393 VAN DYKE STE 209
STERLING HTS MI
48313-4637
US

V. Phone/Fax

Practice location:
  • Phone: 586-274-4394
  • Fax: 586-274-4701
Mailing address:
  • Phone: 586-274-4394
  • Fax: 586-274-4701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801032921
License Number StateMI

VIII. Authorized Official

Name: MS. DENISE SPENCER
Title or Position: PRESIDENT
Credential: LMSW
Phone: 586-274-4394