Provider Demographics
NPI:1063200046
Name:BROSSIA, CAROL MARIE (LMSW)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:MARIE
Last Name:BROSSIA
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:MARIE
Other - Last Name:BLAIR, BROSSIA, BLAIR-BROSSIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:41673 BEDFORD DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3703
Mailing Address - Country:US
Mailing Address - Phone:734-363-4513
Mailing Address - Fax:
Practice Address - Street 1:34290 FORD RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-3051
Practice Address - Country:US
Practice Address - Phone:888-813-8326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health