Provider Demographics
NPI:1184863730
Name:KROUSE, KEVIN CHRISTOPHER I (CADC-II, DOT/SAP)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:CHRISTOPHER
Last Name:KROUSE
Suffix:I
Gender:
Credentials:CADC-II, DOT/SAP
Other - Prefix:MR
Other - First Name:KEVIN
Other - Middle Name:CHRISTOPHER
Other - Last Name:KROUSE
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:CADC-II, DOT/SAP
Mailing Address - Street 1:1126 CORONEL STREET
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-2357
Mailing Address - Country:US
Mailing Address - Phone:323-743-9389
Mailing Address - Fax:
Practice Address - Street 1:11000 W MCNICHOLS RD
Practice Address - Street 2:SUITE B3
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-2357
Practice Address - Country:US
Practice Address - Phone:313-863-5554
Practice Address - Fax:313-863-4711
Is Sole Proprietor?:No
Enumeration Date:2009-02-05
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI821045101YA0400X
CAA044070417172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)