Provider Demographics
NPI:1477897536
Name:KATRINA MOTRINC, LLC
Entity Type:Organization
Organization Name:KATRINA MOTRINC, LLC
Other - Org Name:CHILD AND FAMILY THERAPY CENTER OF MACOMB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTRINC
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:586-232-5089
Mailing Address - Street 1:57327 VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48094-2892
Mailing Address - Country:US
Mailing Address - Phone:586-232-5089
Mailing Address - Fax:
Practice Address - Street 1:57327 VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MI
Practice Address - Zip Code:48094-2892
Practice Address - Country:US
Practice Address - Phone:248-232-5089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010862101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty