Healthcare Provider Details

I. General information

NPI: 1558646315
Provider Name (Legal Business Name): VERNICE ALFREDA GAITHER BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26300 OUTER DR
LINCOLN PARK MI
48146-2019
US

IV. Provider business mailing address

26300 OUTER DR
LINCOLN PARK MI
48146-2019
US

V. Phone/Fax

Practice location:
  • Phone: 313-388-4630
  • Fax: 313-388-0472
Mailing address:
  • Phone: 313-388-4630
  • Fax: 313-388-0472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6803086349
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: