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General NPI Number Information
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NPI Number | 1164918744
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Entity Type | Organization
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Legal Business Name | FACILITATING CHANGE, PLLC
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Dates
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Enumeration Date | 07/06/2018
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Last Update Date | 07/06/2018
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Provider Practice Location Address
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Address Line | 47567 DENNIS BAERT DR
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City | MACOMB
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State | MI
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Zip | 48044-3063
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Country | US
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Telephone | 586-292-7214
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Fax |
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Provider Business Mailing Address
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Address Line | 47567 DENNIS BAERT DR
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City | MACOMB
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State | MI
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Zip | 48044-3063
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | KAREN WETZEL
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Credential | LMSW,ACSW
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Telephone | 586-292-7214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6801077223
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License Number State | MI
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