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General NPI Number Information
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NPI Number | 1942851670
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Entity Type | Organization
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Legal Business Name | KN MENTAL HEALTH SERVICES LLC
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Dates
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Enumeration Date | 09/24/2019
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Last Update Date | 09/24/2019
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Provider Practice Location Address
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Address Line | 1111 HALL ROAD
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City | UTICA
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State | MI
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Zip | 48317
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Country | US
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Telephone | 586-697-0218
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Fax |
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Provider Business Mailing Address
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Address Line | 57808 APPLE CREEK DR
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City | WASHINGTON
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State | MI
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Zip | 48094-3227
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Country | US
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Telephone | 586-246-8903
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | KATHLEEN NOWICKI
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Credential | LMSW
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Telephone | 586-246-8903
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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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