Healthcare Provider Details

I. General information

NPI: 1528612843
Provider Name (Legal Business Name): AMERICAN TRINITY PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 09/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 W BIG BEAVER RD
TROY MI
48084-3501
US

IV. Provider business mailing address

22200 W 11 MILE RD UNIT 224
SOUTHFIELD MI
48037-7008
US

V. Phone/Fax

Practice location:
  • Phone: 347-419-4833
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. THEADIA CAREY
Title or Position: CLINICIAN
Credential: MD
Phone: 248-251-0354