Provider Demographics
NPI:1629209887
Name:GERIOS, MARK GEOFFREY (MA LLPC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:GEOFFREY
Last Name:GERIOS
Suffix:
Gender:M
Credentials:MA LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37512 CHARTER OAKS
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-2422
Mailing Address - Country:US
Mailing Address - Phone:586-477-0005
Mailing Address - Fax:586-477-0005
Practice Address - Street 1:751 E GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-2529
Practice Address - Country:US
Practice Address - Phone:313-922-2222
Practice Address - Fax:313-922-8771
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006214101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)