Healthcare Provider Details

I. General information

NPI: 1528896065
Provider Name (Legal Business Name): MADISON HILT LLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8150 OLD 13 MILE RD
WARREN MI
48093-8700
US

IV. Provider business mailing address

6549 TOWN CENTER DR STE A
CLARKSTON MI
48346-4824
US

V. Phone/Fax

Practice location:
  • Phone: 800-395-3223
  • Fax: 248-620-6405
Mailing address:
  • Phone: 800-395-3223
  • Fax: 248-620-6405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451023786
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: