=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376706069
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SANDRA OVERSTREET-WARE LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2008
-----------------------------------------------------
Last Update Date | 12/21/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3815 W FORT ST
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-510-6189
-----------------------------------------------------
Fax | 313-393-7883
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1300 LAFAYETTE EAST SUITE 2001
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-510-6189
-----------------------------------------------------
Fax | 313-393-7883
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 6801020425
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------