Healthcare Provider Details

I. General information

NPI: 1639302458
Provider Name (Legal Business Name): LINA ESCAMILLA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W 5TH AVE
FLINT MI
48503-2445
US

IV. Provider business mailing address

420 W 5TH AVE
FLINT MI
48503-2445
US

V. Phone/Fax

Practice location:
  • Phone: 810-257-3740
  • Fax:
Mailing address:
  • Phone: 810-257-3740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801091383
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: