Individual
MR. KENNETH DWAYNE PERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
23700 VAN DYKE AVE, WARREN, MI 48089-1600
(586) 758-6670
(586) 758-0243
Mailing address
58868 VIRGINIA CIR, NEW HAVEN, MI 48048-2797
(586) 749-5266
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
M-10161 M
—
MI
05
—
M-10162 M
—
MI
Enumeration date
03/19/2007
Last updated
10/23/2009
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