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NPI Code Detail

MEDICARE: C.W. ENTERPRISE LLC

MEDICARE: C.W. ENTERPRISE LLC
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
1101YM0800XMental Health Counselor
2101YP2500XProfessional Counselor
3103TC1900XCounseling Psychologist
42084P0800XPsychiatry Physician
5104100000XSocial Worker

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1BCBSOTHERMI10591

General Provider Information

NPI Number : 1982655544
Entity Type Code : Organization
Provider Name (Legal Business Name) : C.W. ENTERPRISE LLC
Provider Business Mailing Address
First Line : 32743 23 MILE RD STE 130
Second Line :
City : CHESTERFIELD
State : MI
Zip : 48047-2082
Country : US
Telephone Number : 586-273-7095
Fax Number : 586-273-7196
Provider Business Practice Location Address
First Line : 32743 23 MILE RD STE 130
Second Line :
City : CHESTERFIELD
State : MI
Zip : 48047-2082
Country : US
Telephone Number : 586-273-7095
Fax Number : 586-273-7196
Authorized Official
Title or Position : OFFICE MANAGER
Name : YOLANDA DOBBYN
Credential :
Telephone Number : 586-273-7095
Provider Enumeration Date : 05/16/2006
Last Update Date : 03/15/2019

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Directions to “C.W. ENTERPRISE LLC ” Practice Location

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