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General NPI Number Information
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NPI Number | 1396275913
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Entity Type | Organization
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Legal Business Name | ACCESS TO CARE, LLC
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Dates
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Enumeration Date | 06/15/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 15800 PROVIDENCE DR ROOM 400 B1
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City | SOUTHFIELD
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State | MI
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Zip | 48075
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Country | US
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Telephone | 248-595-8681
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Fax |
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Provider Business Mailing Address
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Address Line | 15800 PROVIDENCE DR RM 400B1
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City | SOUTHFIELD
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State | MI
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Zip | 48075-3145
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Country | US
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Telephone | 248-595-8681
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Fax |
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Authorized Official
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Title or Position | MEMEBER
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Name | EVONNE RENAE WILLIAMS
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Credential | MSW
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Telephone | 248-595-8681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 6801086344
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License Number State | MI
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