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General NPI Number Information
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NPI Number | 1497671671
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Entity Type | Organization
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Legal Business Name | MICHIGAN CENTER FOR TRAUMATIC STRESS
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Dates
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Enumeration Date | 06/24/2026
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Last Update Date | 06/24/2026
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Provider Practice Location Address
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Address Line | 21611 E 11 MILE RD
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48081-1636
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Country | US
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Telephone | 586-944-2902
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Fax |
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Provider Business Mailing Address
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Address Line | 21611 E 11 MILE RD
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48081-1636
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Country | US
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Telephone | 586-944-2902
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SYLVIA ROSE JOHNSON
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Credential |
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Telephone | 248-330-5770
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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