Healthcare Provider Details

I. General information

NPI: 1295781730
Provider Name (Legal Business Name): CHRISTINA EVA REPAY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31000 TELEGRAPH RD STE 120
BINGHAM FARMS MI
48025-4321
US

IV. Provider business mailing address

31000 TELEGRAPH RD STE 120
BINGHAM FARMS MI
48025-4321
US

V. Phone/Fax

Practice location:
  • Phone: 248-594-4991
  • Fax:
Mailing address:
  • Phone: 248-594-4991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801073955
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: