Healthcare Provider Details

I. General information

NPI: 1770610834
Provider Name (Legal Business Name): MACOMB COUNTY COMMUNITY MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 E 13 MILE RD SUITE B
WARREN MI
48092-3795
US

IV. Provider business mailing address

16150 WOODCOCK DR
MACOMB MI
48044-3245
US

V. Phone/Fax

Practice location:
  • Phone: 586-274-0200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1
License Number StateMI

VIII. Authorized Official

Name: MRS. MICHELLE MODLINSKI
Title or Position: RN
Credential:
Phone: 586-274-0200