Healthcare Provider Details

I. General information

NPI: 1215629746
Provider Name (Legal Business Name): AMBER BARKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 08/18/2026
Certification Date: 07/10/2023
Deactivation Date: 07/10/2023
Reactivation Date: 08/18/2026

III. Provider practice location address

1367 MARYLAND ST
GROSSE POINTE PARK MI
48230-1005
US

IV. Provider business mailing address

1367 MARYLAND ST
GROSSE POINTE PARK MI
48230-1005
US

V. Phone/Fax

Practice location:
  • Phone: 313-591-2969
  • Fax:
Mailing address:
  • Phone: 313-591-2969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6851116615
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: