Provider Demographics
NPI:1902686637
Name:COTTER, MARY CATHERINE
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:COTTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30671 STEPHENSON HWY STE C
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-1652
Mailing Address - Country:US
Mailing Address - Phone:248-850-1600
Mailing Address - Fax:
Practice Address - Street 1:30671 STEPHENSON HWY STE C
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1652
Practice Address - Country:US
Practice Address - Phone:248-850-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)