Healthcare Provider Details

I. General information

NPI: 1659923159
Provider Name (Legal Business Name): SHERRY R SCOTT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2019
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 HILTON RD
FERNDALE MI
48220-1017
US

IV. Provider business mailing address

16021 DUGAN ST
ROSEVILLE MI
48066-1480
US

V. Phone/Fax

Practice location:
  • Phone: 586-738-4374
  • Fax:
Mailing address:
  • Phone: 586-738-4374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHERRY REGINA SCOTT
Title or Position: CEO
Credential: LMSW
Phone: 586-738-4374