Healthcare Provider Details

I. General information

NPI: 1619541174
Provider Name (Legal Business Name): ELISE SARAH PEARL-HIPPS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELISE SARAH ADKINS PHD

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD
DETROIT MI
48202-2608
US

IV. Provider business mailing address

1 FORD PL STE 3A
DETROIT MI
48202-3450
US

V. Phone/Fax

Practice location:
  • Phone: 800-653-6568
  • Fax: 313-916-7263
Mailing address:
  • Phone: 800-999-5829
  • Fax: 313-876-1305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301019488
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301019488
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: