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General NPI Number Information
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NPI Number | 1154470755
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Entity Type | Organization
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Legal Business Name | ACCESS CHRISTIAN COUNSELING
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 12/01/2010
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Provider Practice Location Address
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Address Line | 29260 FRANKLIN RD SUITE 121
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1161
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Country | US
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Telephone | 248-355-4300
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Fax | 248-355-4393
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Provider Business Mailing Address
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Address Line | 29260 FRANKLIN RD SUITE 121
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1161
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Country | US
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Telephone | 248-355-4300
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Fax | 248-355-4393
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. CHARLES EARNEST CAPICCHIONI
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Credential | PSY.D., L.L.P.
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Telephone | 248-355-4300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 6301010435
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301012712
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License Number State | MI
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