Healthcare Provider Details

I. General information

NPI: 1215139738
Provider Name (Legal Business Name): COLLEEN MARIE BLANCHFIELD LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15370 LEVAN ROAD SUITE 2 HEGIRA PROGRAMS INC LIVONIA COUNSELING CENTER
LIVONIA MI
48154
US

IV. Provider business mailing address

22729 CRANBROOKE DRIVE
NOVI MI
48375
US

V. Phone/Fax

Practice location:
  • Phone: 734-744-0170
  • Fax: 734-744-0171
Mailing address:
  • Phone: 248-348-0946
  • Fax: 248-348-0946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801086823
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: