Provider Demographics
NPI:1841989951
Name:SLATTERY, KAREN (MSW, LCAC, CAAC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:SLATTERY
Suffix:
Gender:F
Credentials:MSW, LCAC, CAAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 733
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48361-0733
Mailing Address - Country:US
Mailing Address - Phone:248-410-4696
Mailing Address - Fax:
Practice Address - Street 1:52 TWEED LN
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48362-2289
Practice Address - Country:US
Practice Address - Phone:248-410-4696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87001475A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty