Healthcare Provider Details

I. General information

NPI: 1093346959
Provider Name (Legal Business Name): CARLA YARBROUGH MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 RIVER PLACE DR STE 250
DETROIT MI
48207-5402
US

IV. Provider business mailing address

100 RIVER PLACE DR STE 250
DETROIT MI
48207-5402
US

V. Phone/Fax

Practice location:
  • Phone: 313-871-2337
  • Fax: 313-871-1805
Mailing address:
  • Phone: 313-871-2337
  • Fax: 313-871-1805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: