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General NPI Number Information
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NPI Number | 1437675758
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Entity Type | Individual
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Provider Name | KENNETH GERARD GILES M.A., L.L.P.C.
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Gender | Male
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Dates
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Enumeration Date | 08/17/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 29532 SOUTHFIELD RD. SUITE 208
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City | SOUTHFIELD
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State | MI
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Zip | 48076
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Country | US
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Telephone | 248-596-6993
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Fax |
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Provider Business Mailing Address
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Address Line | 29532 SOUTHFIELD RD STE 208
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City | SOUTHFIELD
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State | MI
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Zip | 48076-2023
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Country | US
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Telephone | 248-596-6993
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6401013774
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License Number State | MI
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