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General NPI Number Information
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NPI Number | 1831757988
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Entity Type | Individual
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Provider Name | CARLOS F WINDOM SR. LLPC
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Gender | Male
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Dates
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Enumeration Date | 06/04/2019
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 20901 MOROSS RD
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City | DETROIT
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State | MI
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Zip | 48236-2058
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Country | US
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Telephone | 313-626-2600
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Fax | 313-626-2605
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Provider Business Mailing Address
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Address Line | 559 W GRAND BLVD
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City | DETROIT
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State | MI
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Zip | 48216-2200
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Country | US
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Telephone | 313-554-0485
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Fax | 313-228-0283
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6401016370
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License Number State | MI
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