Provider Demographics
NPI:1033209366
Name:OPSOMMER, MICHAEL JAMES (LMSW, CAC1)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JAMES
Last Name:OPSOMMER
Suffix:
Gender:M
Credentials:LMSW, CAC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11735 CRESTVIEW RD
Mailing Address - Street 2:
Mailing Address - City:WHITMORE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48189-9309
Mailing Address - Country:US
Mailing Address - Phone:734-449-4607
Mailing Address - Fax:517-485-3513
Practice Address - Street 1:2300 GENOA BUSINESS PARK DR STE 180
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-7374
Practice Address - Country:US
Practice Address - Phone:810-220-2787
Practice Address - Fax:810-220-2834
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801062764101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional