Healthcare Provider Details

I. General information

NPI: 1548109523
Provider Name (Legal Business Name): ELISE PILCHAK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 RIDGEDALE AVE
BIRMINGHAM MI
48009-5767
US

IV. Provider business mailing address

860 RIDGEDALE AVE
BIRMINGHAM MI
48009-5767
US

V. Phone/Fax

Practice location:
  • Phone: 248-702-4231
  • Fax:
Mailing address:
  • Phone: 248-702-4231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: ELISE PILCHAK
Title or Position: OWNER
Credential: PSYD LP
Phone: 248-702-4231