MEDICARE: MRS. CATHERINE ANN PANIK CAC-II, ICADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	2-00749	MI

General Provider Information

NPI Number	:	1275667354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CATHERINE ANN PANIK CAC-II, ICADC

Provider Business Mailing Address
First Line	:	2313 PINE MEADOW DR
Second Line	:
City	:	NEWPORT
State	:	MI
Zip	:	48166-9197
Country	:	US
Telephone Number	:	313-549-4404
Fax Number	:

Provider Business Practice Location Address
First Line	:	1415 TRUMBULL ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48216-1368
Country	:	US
Telephone Number	:	313-964-2030
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/08/2007

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