Healthcare Provider Details

I. General information

NPI: 1932867264
Provider Name (Legal Business Name): LLOYD EDWARD HOLTON III LLBSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2021
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

882 OAKMAN BLVD STE C
DETROIT MI
48238-4019
US

IV. Provider business mailing address

882 OAKMAN BLVD STE C
DETROIT MI
48238-4019
US

V. Phone/Fax

Practice location:
  • Phone: 313-961-4890
  • Fax:
Mailing address:
  • Phone: 313-961-4890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6802091271
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: