Individual
JOHN SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA LPC CRC SCL
Contact information
Practice address
9315 TELEGRAPH RD, REDFORD, MI 48239-1260
(313) 450-4500
Mailing address
2775 COLRAIN DR, WATERFORD, MI 48328-3618
(248) 738-6646
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
00014088
MI
101YP2500X
Professional Counselor
Primary
6401005523
MI
101YS0200X
School Counselor
MI-SC0000000749838
MI
Other
Enumeration date
10/30/2014
Last updated
09/20/2018
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