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General NPI Number Information
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NPI Number | 1750911087
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Entity Type | Individual
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Provider Name | NICOLE C CLAY
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Gender | Female
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Dates
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Enumeration Date | 01/26/2020
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Last Update Date | 01/26/2020
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Provider Practice Location Address
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Address Line | 3200 GREENFIELD RD STE 300
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City | DEARBORN
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State | MI
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Zip | 48120-1805
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Country | US
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Telephone | 313-318-8208
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 442563
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City | DETROIT
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State | MI
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Zip | 48244-2563
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Country | US
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Telephone | 313-318-8208
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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 | 6401017971
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License Number State | MI
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