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Organization
PRO MED SUBSTANCE ABUSE PROGRAM LLC
Active
Organization
PRO MED SUBSTANCE ABUSE PROGRAM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK WOLODKOWICZ (ADMINISTRATOR)
(248) 726-0127
Entity
Organization
Contact information
Practice address
2891 E. MAPLE RD. SUITE 200, TROY, MI 48083
(248) 726-0127
Mailing address
2891 E. MAPLE RD. SUITE 200, TROY, MI 48083
(248) 726-0127
(248) 726-0127
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
NULL
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
NULL
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
1041C0700X
Clinical Social Worker
—
NULL
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
08/03/2012
Last updated
11/01/2016
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