Healthcare Provider Details

I. General information

NPI: 1003261488
Provider Name (Legal Business Name): YOLANDA FARR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 RIVER PLACE DR SUITE 100
DETROIT MI
48207-4274
US

IV. Provider business mailing address

100 RIVER PLACE DR SUITE 100
DETROIT MI
48207-4274
US

V. Phone/Fax

Practice location:
  • Phone: 313-871-2337
  • Fax:
Mailing address:
  • Phone: 313-871-2337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6802072487
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: