Individual
BETHANY BASIRICO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., LPC, NCC, SCL
Contact information
Practice address
5716 MICHIGAN AVE, DETROIT, MI 48210-3039
(313) 963-2266
Mailing address
1902 ROSELAND AVE, ROYAL OAK, MI 48073-3931
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6401010166
MI
Other
Enumeration date
04/19/2011
Last updated
04/19/2011
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