Provider Demographics
NPI:1538546775
Name:WARMACK, ROBERT III
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:WARMACK
Suffix:III
Gender:M
Credentials:
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 2312
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-0312
Mailing Address - Country:US
Mailing Address - Phone:313-444-7992
Mailing Address - Fax:
Practice Address - Street 1:24293 TELEGRAPH RD
Practice Address - Street 2:SUITE 218
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-3011
Practice Address - Country:US
Practice Address - Phone:313-444-7992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-27
Last Update Date:2016-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010514101YP2500X
MISC0000692101YS0200X
00101760225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor