Organization
COUNSELING ASSOCIATES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEX J. GROSSBERG (CREDENTIALING COORDINATOR)
(248) 626-1500
Entity
Organization
Contact information
Practice address
6960 ORCHARD LAKE RD, 100, WEST BLOOMFIELD, MI 48322-4515
(248) 626-1500
Mailing address
6960 ORCHARD LAKE RD, 100, WEST BLOOMFIELD, MI 48322-4515
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0P11960
MEDICARE PTAN
—
01
—
0P12130
MEDICARE PTAN
—
01
—
0P12140
MEDICARE PTAN
—
Enumeration date
03/29/2011
Last updated
03/29/2011
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