Healthcare Provider Details

I. General information

NPI: 1952688814
Provider Name (Legal Business Name): ASCENSION EASTWOOD BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2011
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45660 SCHOENHERR RD
SHELBY TOWNSHIP MI
48315-6033
US

IV. Provider business mailing address

2800 LIVERNOIS RD STE 500
TROY MI
48083-1219
US

V. Phone/Fax

Practice location:
  • Phone: 586-566-3020
  • Fax: 586-566-3055
Mailing address:
  • Phone: 248-680-8203
  • Fax: 248-680-8030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: STEVEN CANDELA
Title or Position: DIRECTOR
Credential: LMSW
Phone: 586-753-0400