Doctor Name: | GARY ADKISSON |
NPI Number: | 1326455320 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LLPC |
License Number: | 6401014373 |
Business Practice Address: | 30500 Van Dyke Ave Suite 209 Warren, MI - 480932195 |
Business Phone Number: | 5865586868 |
Business Fax Number: | |
Mailing Address: | 30500 Van Dyke Ave, Suite 209 WARREN |
State: | MI |
Postal Code: | 480932195 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 07/22/2014 |
NPI Last Update Date: | 07/22/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | 6401014373 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |