Healthcare Provider Details

I. General information

NPI: 1235892084
Provider Name (Legal Business Name): FLOCK GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 12/17/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27550 GROVELAND ST
ROSEVILLE MI
48066-4354
US

IV. Provider business mailing address

27550 GROVELAND ST
ROSEVILLE MI
48066-4354
US

V. Phone/Fax

Practice location:
  • Phone: 586-213-2837
  • Fax:
Mailing address:
  • Phone: 586-213-2837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. LAMIKA BANKS
Title or Position: SOCIAL WORKER
Credential: LMSW
Phone: 586-213-2837