Healthcare Provider Details

I. General information

NPI: 1932019619
Provider Name (Legal Business Name): CARLY EVATZ
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25345 TAFT RD
NOVI MI
48374-2423
US

IV. Provider business mailing address

25345 TAFT RD
NOVI MI
48374-2423
US

V. Phone/Fax

Practice location:
  • Phone: 248-449-1400
  • Fax:
Mailing address:
  • Phone: 248-449-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6851117750
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: