Healthcare Provider Details

I. General information

NPI: 1013024942
Provider Name (Legal Business Name): MR. DANIEL M CARLOCK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DANIEL CARLOCK LLPC, CAADC

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 01/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 STEPHENSON HWY SUITE 250
TROY MI
48083-1123
US

IV. Provider business mailing address

1089 MAPLE HEIGHTS DR
WHITE LAKE MI
48386-1814
US

V. Phone/Fax

Practice location:
  • Phone: 248-585-3239
  • Fax: 248-616-9759
Mailing address:
  • Phone: 586-770-7866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6801063358
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: