Healthcare Provider Details

I. General information

NPI: 1164995601
Provider Name (Legal Business Name): JOSHUA STRODE LLMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2019
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6549 TOWN CENTER DR
CLARKSTON MI
48346-4824
US

IV. Provider business mailing address

41460 W ARCHWOOD DR APT A325
VAN BUREN TWP MI
48111-4509
US

V. Phone/Fax

Practice location:
  • Phone: 248-620-6400
  • Fax:
Mailing address:
  • Phone: 734-999-7567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801103990
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: