Healthcare Provider Details

I. General information

NPI: 1700265469
Provider Name (Legal Business Name): CUTRINA PATRICE CLAXTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CUTRINA PATRICE BURSE

II. Dates (important events)

Enumeration Date: 05/27/2015
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35425 W MICHIGAN AVE
WAYNE MI
48184-9800
US

IV. Provider business mailing address

35425 W MICHIGAN AVE
WAYNE MI
48184-9800
US

V. Phone/Fax

Practice location:
  • Phone: 734-467-7600
  • Fax: 734-467-7646
Mailing address:
  • Phone: 734-467-7600
  • Fax: 734-467-7646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401224385
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: