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General NPI Number Information
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NPI Number | 1376370361
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Entity Type | Organization
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Legal Business Name | CHANCE ONE LLC
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Dates
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Enumeration Date | 09/16/2024
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 21751 W 11 MILE RD STE 100
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City | SOUTHFIELD
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State | MI
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Zip | 48076-3779
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Country | US
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Telephone | 248-662-8667
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Fax |
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Provider Business Mailing Address
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Address Line | 22638 NOTTINGHAM LN
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City | SOUTHFIELD
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State | MI
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Zip | 48033-3393
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Country | US
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Telephone | 313-778-2532
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. SHELL FREEMAN
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Credential | LCSW, MSW
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Telephone | 248-662-8667
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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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