PRO MED SUBSTANCE ABUSE PROGRAM LLC (NPI# 1861748238) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861748238 |
| Entity Type | Organization |
| Organization Name | PRO MED SUBSTANCE ABUSE PROGRAM LLC |
| Practice Address |
2891 E. Maple Rd. Suite 200 Troy MI 48083 |
| Practice Telephone | 2487260127 |
| Mailing Telephone | 2487260127 |
| Mailing Fax Number | 2487260127 |
| Enumeration Date | 2012-08-03 |
| Last Update Date | 2016-11-01 |
| Authorized Official Name | MR. MARK WOLODKOWICZ (ADMINISTRATOR) |
| Authorized Official Telephone | 2487260127 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TA0400X |
Psychologist Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers | ||
| N | 1041C0700X |
Social Worker Specialization: Clinical |
Behavioral Health & Social Service Providers | ||
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers |
| Street Address |
2891 E. MAPLE RD. SUITE 200 |
| City | TROY |
| State | MI |
| Zip Code | 48083 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417420449 | Thapasvi Muttirevula | Physical Therapist | 2422 Cedar Knoll Dr, Troy, MI 48083 | 2019-01-02 |
| 1114418290 | Ann Katchke | Physical Therapist | 3179 Livernois Rd, Troy, MI 48083 | 2018-05-23 |
| 1518485945 | Risa Rae Mendelson | Counselor | 1059 Owendale Street, Troy, MI 48083 | 2017-09-06 |
| 1497277115 | Gassan Asadi | Pharmacist | 215 E Big Beaver Rd Ste 500, Troy, MI 48083 | 2017-07-14 |
| 1528510328 | Dylan Skye Polasko | Behavioral Analyst | 2221 E 4th St, #101, Troy, MI 48083 | 2016-10-27 |
| 1235683061 | Sadia Ghazi | Technician, Other | 3178 Daley Dr., Troy, MI 48083 | 2016-08-10 |
| 1548664345 | Amber Leigh Ernst | Social Worker | 1225 E. Big Beaver Road, Troy, MI 48083 | 2014-10-22 |
| 1356782411 | Michelle Louise Knoblock | Nurse Anesthetist, Certified Registered | 1560 E Maple Rd Ste 100, Troy, MI 48083 | 2013-07-17 |
| 1437400728 | Oakland Physicians Surgery Center | Clinic/Center | 1560 E. Maple Road, Suite 100, Troy, MI 48083 | 2012-09-26 |
| 1104102227 | Jerry Keith Oermann | Psychologist | 2221 Livernois Rd., Ste. 101, Troy, MI 48083 | 2011-11-03 |
| Find all providers in zip 48083 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447742580 | Rebecca Jane Stros | Counselor | 900 Tower Dr, Troy, MI 48098 | 2018-06-05 |
| 1861903858 | Anew Perspective, Inc. | Counselor | 9 Maplebrooke Ct, Troy, IL 62294-2544 | 2017-10-17 |
| 1720448665 | Milestone Recovery Services LLC | Counselor | 225 N Main St # B, Troy, NC 27371-3061 | 2016-03-04 |
| 1679811855 | Jessica A Bennett | Counselor | 888 W Big Beaver Rd Ste 780, Troy, MI 48084-4745 | 2013-01-23 |
| 1942593124 | Taisiya Tess Larina | Counselor | 1801 6th Avenue, Continuing Treatment Services, Troy, NY 12180-3440 | 2011-05-23 |
| 1598054587 | Janice Ann Mills | Counselor | 1385 Creech School Road, Troy, MO 63379 | 2011-03-31 |
| 1194966176 | Eileen C Becker | Counselor | 1059 N. Market Street, Troy, OH 45373-1337 | 2009-03-20 |
| 1720237662 | Emily Sigel | Counselor | 16 1st St., Troy, NY 12180-3802 | 2008-09-16 |
| 1760631154 | David A Lorenzo | Counselor | 16 1st St, Troy, NY 12180-3802 | 2008-09-10 |
| 1093803322 | Edward J Witte | Counselor | 315 Public Sq, 209, Troy, OH 45373-5202 | 2006-10-11 |
| Find all providers in TROY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.