Provider Demographics
NPI:1376972299
Name:CATHOLIC CHARITIES OF SOUTH EASTERN MICHIGAN
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES OF SOUTH EASTERN MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CODY
Authorized Official - Middle Name:BARNWELL
Authorized Official - Last Name:KEARSE
Authorized Official - Suffix:
Authorized Official - Credentials:LLPC
Authorized Official - Phone:248-918-3422
Mailing Address - Street 1:3354 PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-6578
Mailing Address - Country:US
Mailing Address - Phone:248-918-3422
Mailing Address - Fax:
Practice Address - Street 1:6637 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1675
Practice Address - Country:US
Practice Address - Phone:248-666-8780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013632251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health