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General NPI Number Information
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NPI Number | 1376193169
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Entity Type | Individual
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Provider Name | SALENA GROSS
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Gender | Female
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Dates
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Enumeration Date | 09/13/2019
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Last Update Date | 09/21/2026
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Provider Practice Location Address
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Address Line | 18620 W 10 MILE RD STE 130
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City | SOUTHFIELD
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State | MI
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Zip | 48075-2667
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Country | US
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Telephone | 313-356-6673
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Fax |
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Provider Business Mailing Address
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Address Line | 27777 INKSTER RD STE 100
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-5326
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Country | US
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Telephone | 248-436-4400
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6451025259
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License Number State | MI
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