Healthcare Provider Details

I. General information

NPI: 1104428408
Provider Name (Legal Business Name): ALEXIS N KUPOVITS-CAVINS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXIS K CAVINS

II. Dates (important events)

Enumeration Date: 11/11/2020
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8765 LEWIS AVE
TEMPERANCE MI
48182-9300
US

IV. Provider business mailing address

8765 LEWIS AVE
TEMPERANCE MI
48182-9300
US

V. Phone/Fax

Practice location:
  • Phone: 734-847-3802
  • Fax: 734-847-3418
Mailing address:
  • Phone: 734-847-3802
  • Fax: 734-847-3418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801107385
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: