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General NPI Number Information
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NPI Number | 1275667354
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Entity Type | Individual
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Provider Name | CATHERINE ANN PANIK CAC-II, ICADC
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Gender | Female
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1415 TRUMBULL ST
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City | DETROIT
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State | MI
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Zip | 48216-1368
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Country | US
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Telephone | 313-964-2030
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Fax |
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Provider Business Mailing Address
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Address Line | 2313 PINE MEADOW DR
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City | NEWPORT
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State | MI
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Zip | 48166-9197
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Country | US
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Telephone | 313-549-4404
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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 | 2-00749
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License Number State | MI
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