Provider Demographics
NPI:1134175607
Name:AUBURN COUNSELING ASSOCIATES, INC.
Entity type:Organization
Organization Name:AUBURN COUNSELING ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEDDA
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:810-744-3300
Mailing Address - Street 1:3600 S DORT HWY
Mailing Address - Street 2:SUITE 44
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-2093
Mailing Address - Country:US
Mailing Address - Phone:810-744-3300
Mailing Address - Fax:810-744-1090
Practice Address - Street 1:3600 S DORT HWY
Practice Address - Street 2:SUITE 44
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-2093
Practice Address - Country:US
Practice Address - Phone:810-744-3300
Practice Address - Fax:810-744-1090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI250051261QR0405X
MI261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
OB56322Medicare ID - Type Unspecified