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General NPI Number Information
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NPI Number | 1699002907
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Entity Type | Organization
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Legal Business Name | FAUSTINIA LOPER, CSW, PC
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Dates
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Enumeration Date | 11/06/2009
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Last Update Date | 11/16/2009
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Provider Practice Location Address
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Address Line | 17515 W 9 MILE RD SUITE 375
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4403
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Country | US
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Telephone | 248-358-6780
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Fax | 248-358-6780
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Provider Business Mailing Address
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Address Line | 17515 W 9 MILE RD SUITE 375
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4403
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Country | US
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Telephone | 248-358-6780
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Fax | 248-358-6780
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Authorized Official
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Title or Position | PRESIDENT/CLINICAL SOCIAL WORKER
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Name | MRS. FAUSTINIA TALISON LOPER
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Credential | MSW
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Telephone | 248-358-6780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6801014838
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License Number State | MI
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