Healthcare Provider Details

I. General information

NPI: 1336367804
Provider Name (Legal Business Name): ASCENSION EASTWOOD BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22151 MOROSS, PB1 SUITE 334
DETROIT MI
48236-2114
US

IV. Provider business mailing address

28000 DEQUINDRE RD
WARREN MI
48092-2468
US

V. Phone/Fax

Practice location:
  • Phone: 313-343-7230
  • Fax: 313-343-7449
Mailing address:
  • Phone: 248-680-8000
  • Fax: 248-292-3852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: SARAH STARKEL
Title or Position: SUPERVISOR
Credential:
Phone: 248-680-8121