Healthcare Provider Details

I. General information

NPI: 1255576799
Provider Name (Legal Business Name): PAULINE CHIEVES MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2008
Last Update Date: 12/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 WOODWARD AVE
DETROIT MI
48202-2142
US

IV. Provider business mailing address

9133 ST MARYS ST
DETROIT MI
48228
US

V. Phone/Fax

Practice location:
  • Phone: 313-875-7601
  • Fax:
Mailing address:
  • Phone: 313-835-7803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801059031
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: