Individual
COLLEEN FAIRCLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MED, RN, CPSS
Contact information
Practice address
24424 W MCNICHOLS RD, DETROIT, MI 48219-3653
(313) 255-0900
(313) 255-1795
Mailing address
24424 W MCNICHOLS RD, DETROIT, MI 48219-3653
(313) 255-0900
(313) 255-1795
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
01/09/2014
Last updated
01/09/2014
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