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General NPI Number Information
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NPI Number | 1225554082
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Entity Type | Organization
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Legal Business Name | EAST MICHIGAN ADULT THERAPY 13 LLC
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Dates
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Enumeration Date | 08/14/2017
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Last Update Date | 02/10/2023
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Provider Practice Location Address
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Address Line | 15700 PROVIDENCE DR APT 120
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City | SOUTHFIELD
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State | MI
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Zip | 48075-3126
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Country | US
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Telephone | 248-246-0906
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Fax | 800-785-1506
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Provider Business Mailing Address
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Address Line | 15700 PROVIDENCE DR APT 120
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City | SOUTHFIELD
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State | MI
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Zip | 48075-3126
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Country | US
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Telephone | 248-246-0906
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Fax | 800-785-1506
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Authorized Official
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Title or Position | OWNER
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Name | MELANIE NICOLE DAVIS
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Credential | MSW
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Telephone | 248-246-0906
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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 | MI
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