Pro Med Substance Abuse Program LLC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Legal business name

PRO MED SUBSTANCE ABUSE PROGRAM LLC

Practice address

2891 E. Maple Rd. Suite 200
Troy, MI 48083

Phone

(248) 726-0127

NPI assigned

Aug 3, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Mark Wolodkowicz

Title

Administrator

Phone

(248) 726-0127

Specialties & licenses 3

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1343952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477958400000",
    "number": "1861748238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2891 E. MAPLE RD. SUITE 200",
            "city": "TROY",
            "state": "MI",
            "postal_code": "48083",
            "telephone_number": "248-726-0127",
            "fax_number": "248-726-0127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2891 E. MAPLE RD. SUITE 200",
            "city": "TROY",
            "state": "MI",
            "postal_code": "48083",
            "telephone_number": "248-726-0127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO MED SUBSTANCE ABUSE PROGRAM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-03",
        "last_updated": "2016-11-01",
        "status": "A",
        "authorized_official_last_name": "WOLODKOWICZ",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "248-726-0127",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.