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General NPI Number Information
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NPI Number | 1639228000
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Entity Type | Organization
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Legal Business Name | PSYCHIATRIC SERVICES OF GROSSE POINTE
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 03/02/2023
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Provider Practice Location Address
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Address Line | 25509 KELLY RD STE A
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City | ROSEVILLE
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State | MI
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Zip | 48066-5823
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Country | US
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Telephone | 586-252-2616
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Fax | 313-563-8443
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Provider Business Mailing Address
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Address Line | 25509 KELLY RD STE A
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City | ROSEVILLE
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State | MI
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Zip | 48066-5823
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Country | US
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Telephone | 586-252-2616
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Fax | 313-563-8443
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Authorized Official
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Title or Position | OWNER
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Name | JAMES DARRYL ADAMO
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Credential |
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Telephone | 586-252-2616
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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 | 6801076906
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801091557
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301006332
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License Number State | MI
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