Provider Demographics
NPI:1922051416
Name:METRO FAMILY SUPPORT COUNSELING PC
Entity type:Organization
Organization Name:METRO FAMILY SUPPORT COUNSELING PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:586-274-4394
Mailing Address - Street 1:39393 VAN DYKE STE 209
Mailing Address - Street 2:
Mailing Address - City:STERLING HTS,
Mailing Address - State:MI
Mailing Address - Zip Code:48313-4637
Mailing Address - Country:US
Mailing Address - Phone:586-274-4394
Mailing Address - Fax:586-274-4701
Practice Address - Street 1:39393 VAN DYKE STE 209,
Practice Address - Street 2:
Practice Address - City:STERLING HTS,
Practice Address - State:MI
Practice Address - Zip Code:48313-4637
Practice Address - Country:US
Practice Address - Phone:586-274-4394
Practice Address - Fax:586-274-4701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010329211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1922051416Medicare UPIN
MI0N42100Medicare UPIN