Healthcare Provider Details

I. General information

NPI: 1093352734
Provider Name (Legal Business Name): SUMMER MORGAN ELLERBEE MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2019
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 WOODWARD AVE FL 2
DETROIT MI
48201-2027
US

IV. Provider business mailing address

4160 WOODWARD AVE FL 2
DETROIT MI
48201-2027
US

V. Phone/Fax

Practice location:
  • Phone: 313-656-4052
  • Fax: 313-656-4053
Mailing address:
  • Phone: 313-656-4052
  • Fax: 313-656-4053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801101517
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: