Provider Demographics
NPI:1033665385
Name:WEEMS, CHARLES (LLMSW)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:WEEMS
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20140 PINEHURST ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-1060
Mailing Address - Country:US
Mailing Address - Phone:313-758-8231
Mailing Address - Fax:
Practice Address - Street 1:MERIDIAN HEALTH SERVICES
Practice Address - Street 2:1255 N. OAKLAND BLVD.
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327
Practice Address - Country:US
Practice Address - Phone:248-406-0090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801099755101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)