Healthcare Provider Details

I. General information

NPI: 1528572567
Provider Name (Legal Business Name): RHONIS ALFRED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2017
Last Update Date: 12/25/2021
Certification Date: 12/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 RUSSELL ST
DETROIT MI
48207-4825
US

IV. Provider business mailing address

1578 SHEFFIELD DR
YPSILANTI MI
48198-3630
US

V. Phone/Fax

Practice location:
  • Phone: 313-396-5300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851111223
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: