Healthcare Provider Details

I. General information

NPI: 1023386398
Provider Name (Legal Business Name): EASTWOOD COMMUNITY CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 07/21/2022
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

28000 DEQUINDRE RD
WARREN MI
48092-2468
US

V. Phone/Fax

Practice location:
  • Phone: 586-566-3020
  • Fax: 586-566-3055
Mailing address:
  • Phone: 586-753-0400
  • Fax: 586-753-0404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number500457
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number500457
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number500457
License Number StateMI

VIII. Authorized Official

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