Healthcare Provider Details

I. General information

NPI: 1184350522
Provider Name (Legal Business Name): EMILY BURCHAM LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 LIVERNOIS ST STE 102
FERNDALE MI
48220-2676
US

IV. Provider business mailing address

504 E WOODWARD HEIGHTS BLVD
HAZEL PARK MI
48030-1447
US

V. Phone/Fax

Practice location:
  • Phone: 616-209-9295
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851107950
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: