Healthcare Provider Details

I. General information

NPI: 1366094500
Provider Name (Legal Business Name): BELKIS LORENA MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 07/09/2019
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:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6801104961
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: