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General NPI Number Information
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NPI Number | 1134930795
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Entity Type | Organization
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Legal Business Name | BLUE BRANCH ADVOCACY AND COUNSELING
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Dates
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Enumeration Date | 01/14/2025
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 22036 CHASE DR
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City | NOVI
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State | MI
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Zip | 48375-4770
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Country | US
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Telephone | 734-237-6067
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Fax |
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Provider Business Mailing Address
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Address Line | 22036 CHASE DR
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City | NOVI
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State | MI
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Zip | 48375-4770
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | MRS. JACINTA ROSE FLOREK
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Credential | LMSW, MPH
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Telephone | 248-225-7799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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