Provider Demographics
NPI:1720434426
Name:WOLVERINE HUMAN SERVICES
Entity Type:Organization
Organization Name:WOLVERINE HUMAN SERVICES
Other - Org Name:MICHIGAN COUNSELING CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FORMER EXECUTIVE DIRECTOR PREVIOUS
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KROLICKI
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-806-4873
Mailing Address - Street 1:20300 SUPERIOR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-6341
Mailing Address - Country:US
Mailing Address - Phone:888-622-3345
Mailing Address - Fax:586-436-3596
Practice Address - Street 1:20300 SUPERIOR
Practice Address - Street 2:SUITE 160
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-6341
Practice Address - Country:US
Practice Address - Phone:888-622-3345
Practice Address - Fax:586-436-3596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010674781041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty