Individual
BLAKE MICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
16645 15 MILE RD STE B, CLINTON TOWNSHIP, MI 48035-2206
(586) 213-5505
Mailing address
16645 15 MILE RD STE B, CLINTON TOWNSHIP, MI 48035-2206
(586) 213-5505
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6401015338
MI
Other
Enumeration date
03/28/2016
Last updated
05/25/2021
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