Organization
AMIR EXECUTIVES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALLEN CUSHINGBERRY PSY.D. (CEO)
(248) 945-0200
Entity
Organization
Contact information
Practice address
19111 WEST TEN MILE ROAD, SUITE 203, SOUTHFIELD, MI 48075-2443
(248) 945-0200
(248) 945-0204
Mailing address
19111 WEST TEN MILE ROAD, SUITE 203, SOUTHFIELD, MI 48075-2443
(248) 945-0200
(248) 945-0204
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6401001831
MI
1041C0700X
Clinical Social Worker
6801062749
MI
Other
Enumeration date
09/08/2006
Last updated
02/18/2009
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