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General NPI Number Information
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NPI Number | 1396360343
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Entity Type | Organization
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Legal Business Name | ANDREA ATWELL
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Dates
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Enumeration Date | 06/15/2020
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Last Update Date | 06/15/2020
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Provider Practice Location Address
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Address Line | 6037 MAYFAIR ST
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City | TAYLOR
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State | MI
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Zip | 48180-1360
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Country | US
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Telephone | 313-242-7326
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Fax | 313-499-9395
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Provider Business Mailing Address
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Address Line | 6037 MAYFAIR ST
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City | TAYLOR
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State | MI
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Zip | 48180-1360
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Country | US
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Telephone | 313-242-7326
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Fax | 313-499-9395
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Authorized Official
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Title or Position | BILLER
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Name | MRS. DOLLY THERESA LEE
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Credential |
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Telephone | 248-343-3249
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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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