Healthcare Provider Details

I. General information

NPI: 1578453866
Provider Name (Legal Business Name): RAJA CANICE MANNING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13955 FARMINGTON RD
LIVONIA MI
48154-5453
US

IV. Provider business mailing address

16711 BURT RD APT 302
DETROIT MI
48219-4096
US

V. Phone/Fax

Practice location:
  • Phone: 248-221-2945
  • Fax:
Mailing address:
  • Phone: 313-434-8927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: