Organization
PRO MED SUBSTANCE ABUSE PROGRAM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK WOLODKOWICZ (ADMINISTRATOR)
(248) 726-0127
Entity
Organization
Contact information
Practice address
2891 E. MAPLE RD. SUITE 200, TROY, MI 48083
(248) 726-0127
Mailing address
2891 E. MAPLE RD. SUITE 200, TROY, MI 48083
(248) 726-0127
(248) 726-0127
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
08/03/2012
Last updated
11/01/2016
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