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General NPI Number Information
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NPI Number | 1861603417
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Entity Type | Individual
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Provider Name | MICHAEL O'BRIEN AAS, CAC-II, SST
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Gender | Male
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 36 W TENNYSON AVE
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City | PONTIAC
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State | MI
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Zip | 48340-2668
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Country | US
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Telephone | 248-454-0407
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Fax | 248-454-6557
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Provider Business Mailing Address
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Address Line | 8301 16 1/2 MILE RD APT 102
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City | STERLING HEIGHTS
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State | MI
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Zip | 48312-1844
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Country | US
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Telephone | 586-795-9465
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Fax | 248-454-6557
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | MI
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