Individual
BENJAMIN KACKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
24424 W MCNICHOLS RD, DETROIT, MI 48219-3653
(313) 255-0900
Mailing address
24424 W MCNICHOLS RD, DETROIT, MI 48219-3653
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6401013356
MI
Other
Enumeration date
01/08/2014
Last updated
01/08/2014
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