Healthcare Provider Details

I. General information

NPI: 1568092492
Provider Name (Legal Business Name): MECIA HALE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2020
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24445 NORTHWESTERN HWY
SOUTHFIELD MI
48075-6501
US

IV. Provider business mailing address

48511 DENTON RD APT 102
VAN BUREN TOWNSHIP MI
48111-1903
US

V. Phone/Fax

Practice location:
  • Phone: 248-475-6300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number111062
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6802090723
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: