Basic Information
| Provider Information | |||||||||
| NPI: | 1144494006 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAYNE-CHARLEY | ||||||||
| FirstName: | MARCELLA | ||||||||
| MiddleName: | MAREA | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22151 MOROSS RD | ||||||||
| Address2: | PB1, STE. 334 | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482362167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3133437230 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 22151 MOROSS RD | ||||||||
| Address2: | PB1, STE. 334 | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482362167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3133437230 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2008 | ||||||||
| LastUpdateDate: | 01/12/2017 | ||||||||
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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 | 101YP2500X | 6401009381 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.