Provider Demographics
NPI:1306557087
Name:TURNER, PAUL ALONZO JR (CADCM)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ALONZO
Last Name:TURNER
Suffix:JR
Gender:M
Credentials:CADCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18313 GILCHRIST ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-3237
Mailing Address - Country:US
Mailing Address - Phone:313-965-7880
Mailing Address - Fax:
Practice Address - Street 1:2727 2ND AVE STE 108
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2673
Practice Address - Country:US
Practice Address - Phone:313-965-7880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISA0822179101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)