Basic Information
| Provider Information | |||||||||
| NPI: | 1063516268 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WICHTNER | ||||||||
| FirstName: | RITA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 51360 PINEWOOD DR | ||||||||
| Address2: | |||||||||
| City: | MACOMB | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480424219 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 400 STODDARD RD. | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 410381038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103922167 | ||||||||
| FaxNumber: | 8103922057 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | MI | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.