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General NPI Number Information
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NPI Number | 1275785727
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Entity Type | Organization
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Legal Business Name | ADVANCED BEHAVIORAL COUNSELING P.C.
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Dates
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Enumeration Date | 10/15/2008
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Last Update Date | 06/17/2009
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Provider Practice Location Address
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Address Line | 117 CASS AVE SUITE 302
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City | MOUNT CLEMENS
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State | MI
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Zip | 48043-2252
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Country | US
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Telephone | 586-466-6130
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Fax |
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Provider Business Mailing Address
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Address Line | 38355 UNION LAKE RD
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48036-2889
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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 | PROVIDER
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Name | COLLEEN FLOOD-ESPINOZA
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Credential |
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Telephone | 586-466-6130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801074529
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License Number State | MI
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