| Doctor Name: | MR. MICHAEL GEORGE BROCK |
| NPI Number: | 1003161282 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MA, LLP, LMSW |
| License Number: | 6301005806 |
| Business Practice Address: | 2514 Biddle Avenue Wyandotte, MI - 48192 |
| Business Phone Number: | 3138020863 |
| Business Fax Number: | 7346921082 |
| Mailing Address: | 2514 Biddle Avenue, WYANDOTTE |
| State: | MI |
| Postal Code: | 48192 |
| Phone Number: | 3138020863 |
| Fax Number: | 7346921082 |
| NPI Enumeration Date: | 07/13/2012 |
| NPI Last Update Date: | 07/13/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TA0400X |
| License Number: | 6301005806 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |