Healthcare Provider Details

I. General information

NPI: 1568307734
Provider Name (Legal Business Name): DAVID JEROME PATTERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 W WALTON BLVD
WATERFORD MI
48329-4191
US

IV. Provider business mailing address

5660 ARBORVIEW CT
WEST BLOOMFIELD MI
48322-1306
US

V. Phone/Fax

Practice location:
  • Phone: 248-461-6266
  • Fax: 248-461-6304
Mailing address:
  • Phone: 608-343-0875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4151001220
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: