Provider Demographics
NPI:1780838466
Name:PERKINS-MCCLUNG AND ASSOCIATES CORP
Entity Type:Organization
Organization Name:PERKINS-MCCLUNG AND ASSOCIATES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BERNALDINE
Authorized Official - Middle Name:PERKINS
Authorized Official - Last Name:MCCLUNG
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, CSW, CAAC
Authorized Official - Phone:313-244-5203
Mailing Address - Street 1:14342 E JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48215-2932
Mailing Address - Country:US
Mailing Address - Phone:313-244-5203
Mailing Address - Fax:313-331-1890
Practice Address - Street 1:14342 E JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48215-2932
Practice Address - Country:US
Practice Address - Phone:313-244-5203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-08
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010816141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty