Individual
MS. MARY ANN MATTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, SWT, CACR
Contact information
Practice address
2710 12 MILE RD, BERKLEY, MI 48072-1630
(248) 543-1090
(248) 543-0017
Mailing address
6181 DAKOTA CIR, BLOOMFIELD HILLS, MI 48301-1565
(248) 227-4279
(248) 543-0017
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
6803074335
MI
Other
Enumeration date
03/19/2007
Last updated
07/08/2007
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