| Doctor Name: | MR. CHARLES NORBURY |
| NPI Number: | 1174648133 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CAC1 |
| License Number: | CAC |
| Business Practice Address: | 2710 12 Mile Rd Berkley, MI - 480721630 |
| Business Phone Number: | 2485431090 |
| Business Fax Number: | 2485430017 |
| Mailing Address: | 575 E Drayton St, FERNDALE |
| State: | MI |
| Postal Code: | 482201328 |
| Phone Number: | 2485431090 |
| Fax Number: | 2485430017 |
| NPI Enumeration Date: | 03/20/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | CAC |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |