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General NPI Number Information
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NPI Number | 1346044377
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Entity Type | Organization
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Legal Business Name | CHRYSALIS THERAPY PLLC
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Dates
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Enumeration Date | 04/01/2025
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 628 E PARENT AVE STE 505
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City | ROYAL OAK
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State | MI
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Zip | 48067-3769
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Country | US
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Telephone | 313-451-0305
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Fax |
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Provider Business Mailing Address
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Address Line | 1491 SPENCER ST
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City | FERNDALE
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State | MI
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Zip | 48220-3505
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Country | US
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Telephone | 517-290-4846
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAURA JOANNE GROSS
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Credential | LMSW
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Telephone | 517-290-4846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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