Individual
BRIAN THEISEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CCAR
Contact information
Practice address
50430 SCHOOL HOUSE RD, CANTON, MI 48187-5910
(734) 751-0320
Mailing address
50430 SCHOOL HOUSE RD, CANTON, MI 48187-5910
(734) 751-0320
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
11/18/2020
Last updated
11/18/2020
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