Healthcare Provider Details

I. General information

NPI: 1417553140
Provider Name (Legal Business Name): MIANNE AFUA ADUFUTSE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date: 02/25/2021
Reactivation Date: 03/09/2023

III. Provider practice location address

43241 CAMBRIDGE DR
STERLING HEIGHTS MI
48313-1812
US

IV. Provider business mailing address

43241 CAMBRIDGE DR
STERLING HEIGHTS MI
48313-1812
US

V. Phone/Fax

Practice location:
  • Phone: 305-924-0303
  • Fax:
Mailing address:
  • Phone: 305-924-0303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1417553140
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501005970
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: