Individual
CHARLES WILLIAM HARRISON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
14507 WOODWARD AVE, HIGHLAND PARK, MI 48203-2905
(313) 723-6100
Mailing address
PO BOX 746723, ATLANTA, GA 30374-6723
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
6801104059
MI
1041C0700X
Clinical Social Worker
Primary
6801114502
MI
Other
Enumeration date
05/13/2019
Last updated
11/04/2022
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