Individual
MR. CARLOS BAXTER MARINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CAC-M
Contact information
Practice address
13575 LESURE ST, DETROIT, MI 48227-3131
(313) 493-4410
(313) 493-4415
Mailing address
13575 LESURE ST, DETROIT, MI 48227-3131
(313) 493-4410
(313) 493-4415
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1-03543
MI
Other
Enumeration date
09/30/2008
Last updated
09/30/2008
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