Individual
MRS. PHYLLIS CAROLINE WALTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LPC
Contact information
Practice address
26522 VAN DYKE AVE, CENTER LINE, MI 48015-1221
(586) 759-4400
Mailing address
6549 TOWN CENTER DR STE A, CLARKSTON, MI 48346-4824
(248) 620-6400
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
401006902
MI
101YP2500X
Professional Counselor
Primary
6401006902
MI
Other
Enumeration date
09/06/2006
Last updated
08/24/2020
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