Healthcare Provider Details

I. General information

NPI: 1932516184
Provider Name (Legal Business Name): SUPPORT MANAGEMENT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2014
Last Update Date: 07/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32231 SCHOOLCRAFT RD SUITE 210
LIVONIA MI
48150-4312
US

IV. Provider business mailing address

32231 SCHOOLCRAFT RD SUITE 210
LIVONIA MI
48150-4312
US

V. Phone/Fax

Practice location:
  • Phone: 734-266-6800
  • Fax:
Mailing address:
  • Phone: 734-266-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number6801019488
License Number StateMI

VIII. Authorized Official

Name: VANESSA STAFFORD
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 734-266-6800