Individual
MRS. GLORIA COUSINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2520 ELIZABETH LAKE RD, WATERFORD, MI 48328-3312
(248) 706-5041
(248) 706-5046
Mailing address
22900 REMICK DR, CLINTON TOWNSHIP, MI 48036-2732
(586) 783-4802
(586) 783-4805
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1-00016
MI
Other
Enumeration date
03/06/2008
Last updated
03/06/2008
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