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General NPI Number Information
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NPI Number | 1487020582
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Entity Type | Organization
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Legal Business Name | CENTER FOR CONFIDENTIAL COUNSELING
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Dates
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Enumeration Date | 08/12/2015
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Last Update Date | 09/28/2015
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Provider Practice Location Address
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Address Line | 16000 W 9 MILE RD STE 507
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4808
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Country | US
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Telephone | 248-388-1221
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Fax |
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Provider Business Mailing Address
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Address Line | 16000 W 9 MILE RD STE 507
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4808
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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 | OWNER
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Name | DR. LEONA MICKLES-BURNS
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Credential | PHD
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Telephone | 248-388-1221
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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 | 6801046764
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License Number State | MI
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