Provider Demographics
NPI:1871626614
Name:WARCHOL, MARK (LMSW, LMFT)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:WARCHOL
Suffix:
Gender:M
Credentials:LMSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 380452
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-0065
Mailing Address - Country:US
Mailing Address - Phone:586-226-1991
Mailing Address - Fax:586-286-1138
Practice Address - Street 1:16950 19 MILE RD
Practice Address - Street 2:SUITE 3A
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-4804
Practice Address - Country:US
Practice Address - Phone:586-226-1991
Practice Address - Fax:586-286-1138
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801060259104100000X
MI4101006085106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist