Healthcare Provider Details

I. General information

NPI: 1003936782
Provider Name (Legal Business Name): JAMES GERARD LIVINGSTON LLMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13101 ALLEN RD SUITE 400
SOUTHGATE MI
48195-2216
US

IV. Provider business mailing address

13101 ALLEN RD SUITE 400
SOUTHGATE MI
48195-2216
US

V. Phone/Fax

Practice location:
  • Phone: 734-785-7705
  • Fax: 734-785-7734
Mailing address:
  • Phone: 734-785-7705
  • Fax: 734-785-7734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801085367
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: