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General NPI Number Information
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NPI Number | 1184863730
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Entity Type | Individual
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Provider Name | KEVIN CHRISTOPHER KROUSE I CADC-II, DOT/SAP
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Gender | Male
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Dates
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Enumeration Date | 02/05/2009
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 11000 W MCNICHOLS RD SUITE B3
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City | DETROIT
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State | MI
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Zip | 48221-2357
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Country | US
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Telephone | 313-863-5554
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Fax | 313-863-4711
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Provider Business Mailing Address
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Address Line | 1126 CORONEL STREET
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City | SAN FERNANDO
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State | CA
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Zip | 91340-2357
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Country | US
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Telephone | 323-743-9389
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 821045
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | A044070417
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License Number State | CA
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