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General NPI Number Information
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NPI Number | 1598092553
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Entity Type | Organization
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Legal Business Name | ANN ARBOR CENTER FOR GROUPS
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Dates
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Enumeration Date | 11/12/2009
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Last Update Date | 11/12/2009
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Provider Practice Location Address
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Address Line | 2301 PACKARD ST
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City | ANN ARBOR
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State | MI
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Zip | 48104-6321
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Country | US
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Telephone | 734-761-9233
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Fax |
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Provider Business Mailing Address
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Address Line | 2301 PACKARD ST
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City | ANN ARBOR
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State | MI
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Zip | 48104-6321
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Country | US
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Telephone | 734-761-9233
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | CAROL BENNETT
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Credential | MSW, LMSW
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Telephone | 734-218-0979
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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 | 6802064924
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License Number State | MI
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