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General NPI Number Information
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NPI Number | 1154861367
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Entity Type | Organization
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Legal Business Name | MDS DEVINE COUNSELING SERVICES
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Dates
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Enumeration Date | 03/07/2017
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Last Update Date | 03/07/2017
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Provider Practice Location Address
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Address Line | 17336 W 12 MILE RD 103
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City | SOUTHFIELD
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State | MI
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Zip | 48076-2113
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Country | US
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Telephone | 248-796-1217
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Fax |
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Provider Business Mailing Address
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Address Line | 9560 LENORE
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City | REDFORD
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State | MI
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Zip | 48239-1664
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Country | US
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Telephone | 248-796-1217
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER/ PROPRIETOR
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Name | MARILYN DENISE SANDERS
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Credential | LCSW, LMSW
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Telephone | 248-796-1217
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6801059552
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License Number State | MI
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