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General NPI Number Information
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NPI Number | 1376972299
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Entity Type | Organization
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Legal Business Name | CATHOLIC CHARITIES OF SOUTH EASTERN MICHIGAN
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Dates
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Enumeration Date | 11/01/2013
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Last Update Date | 11/01/2013
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Provider Practice Location Address
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Address Line | 6637 HIGHLAND RD
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City | WATERFORD
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State | MI
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Zip | 48327-1675
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Country | US
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Telephone | 248-666-8780
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Fax |
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Provider Business Mailing Address
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Address Line | 3354 PRAIRIE AVE
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City | ROYAL OAK
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State | MI
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Zip | 48073-6578
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Country | US
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Telephone | 248-918-3422
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH COUNSELOR
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Name | MR. CODY BARNWELL KEARSE
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Credential | LLPC
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Telephone | 248-918-3422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6401013632
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License Number State | MI
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