Healthcare Provider Details

I. General information

NPI: 1942104971
Provider Name (Legal Business Name): ELIZABETH ANNE MANCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30100 TELEGRAPH RD STE 333
BINGHAM FARMS MI
48025-4561
US

IV. Provider business mailing address

1867 WEBSTER ST
BIRMINGHAM MI
48009-6869
US

V. Phone/Fax

Practice location:
  • Phone: 248-509-4611
  • Fax:
Mailing address:
  • Phone: 810-357-1130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6451025272
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: