Healthcare Provider Details

I. General information

NPI: 1780318642
Provider Name (Legal Business Name): RACHEL VANDERBUSH LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HERITAGE DR STE 520
SOUTHGATE MI
48195-3051
US

IV. Provider business mailing address

20835 SHERWOOD RD
BELLEVILLE MI
48111-9381
US

V. Phone/Fax

Practice location:
  • Phone: 800-693-1916
  • Fax:
Mailing address:
  • Phone: 734-732-8688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4851114255
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: