Basic Information
| Provider Information | |||||||||
| NPI: | 1851521520 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SLUBOWSKI | ||||||||
| FirstName: | GREGG | ||||||||
| MiddleName: | ALLEN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.A. LLPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 45677 WATERSIDE DR | ||||||||
| Address2: | |||||||||
| City: | MACOMB | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480445322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5865310102 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 15945 CANAL RD | ||||||||
| Address2: | |||||||||
| City: | CLINTON TWP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480381610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5864162300 | ||||||||
| FaxNumber: | 5864162311 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2009 | ||||||||
| LastUpdateDate: | 07/16/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 641011419 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.