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General NPI Number Information
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NPI Number | 1669286639
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Entity Type | Individual
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Provider Name | COLIN J DUFFY
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Gender | Male
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Dates
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Enumeration Date | 02/01/2025
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Last Update Date | 02/01/2025
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Provider Practice Location Address
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Address Line | 15173 NORTH RD STE 100
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City | FENTON
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State | MI
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Zip | 48430-1381
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Country | US
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Telephone | 810-771-4074
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Fax |
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Provider Business Mailing Address
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Address Line | 8490 ALTA VISTA DR
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City | PINCKNEY
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State | MI
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Zip | 48169-8480
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Country | US
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Telephone | 810-626-8882
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6451024015
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License Number State | MI
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