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General NPI Number Information
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NPI Number | 1720557093
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Entity Type | Organization
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Legal Business Name | BLOOMFIELD CHILD & FAMILY COUNSELING PLLC
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Dates
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Enumeration Date | 11/16/2018
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 3290 W BIG BEAVER RD STE 230
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City | TROY
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State | MI
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Zip | 48084-2903
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Country | US
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Telephone | 248-238-8702
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Fax |
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Provider Business Mailing Address
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Address Line | 7451 WELLBOURNE CT
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48301-3766
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Country | US
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Telephone | 517-256-0896
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | JESSICA NICOLE CORTEZ
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Credential | LMSW
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Telephone | 248-457-5178
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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 |
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License Number State |
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