Basic Information
| Provider Information | |||||||||
| NPI: | 1740530773 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PADULA | ||||||||
| FirstName: | KATIE | ||||||||
| MiddleName: | ALYSSA | ||||||||
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| Credential: | M.A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20174 WINDEMERE DR | ||||||||
| Address2: | |||||||||
| City: | MACOMB | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480443524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106148760 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 29750 HARPER AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT CLAIR SHORES | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480822607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867773200 | ||||||||
| FaxNumber: | 5867777855 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2012 | ||||||||
| LastUpdateDate: | 02/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6401013271 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.