Provider Demographics
NPI:1396349932
Name:DE MARILLAC COUNSELING LLC
Entity type:Organization
Organization Name:DE MARILLAC COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:PERUGI
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW CAADC
Authorized Official - Phone:734-674-4772
Mailing Address - Street 1:37772 CHARTER OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-4435
Mailing Address - Country:US
Mailing Address - Phone:734-674-4772
Mailing Address - Fax:586-948-8758
Practice Address - Street 1:37772 CHARTER OAKS BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48036-4435
Practice Address - Country:US
Practice Address - Phone:734-674-4772
Practice Address - Fax:586-948-8758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health