Basic Information
| Provider Information | |||||||||
| NPI: | 1053766337 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KACALA | ||||||||
| FirstName: | CORTNEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 626 DARWIN ST | ||||||||
| Address2: | |||||||||
| City: | WESTLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481864506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485060439 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8623 N WAYNE RD | ||||||||
| Address2: | 200 | ||||||||
| City: | WESTLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481851137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344584601 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2016 | ||||||||
| LastUpdateDate: | 04/25/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.