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General NPI Number Information
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NPI Number | 1730889742
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Entity Type | Organization
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Legal Business Name | ADDIE LANTERMAN THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 03/08/2023
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Last Update Date | 03/25/2024
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Provider Practice Location Address
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Address Line | 2540 HARTE DR STE A
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City | BRIGHTON
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State | MI
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Zip | 48114-7014
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Country | US
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Telephone | 567-703-0929
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Fax | 734-703-0929
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Provider Business Mailing Address
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Address Line | 211 N 1ST ST STE 286
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City | BRIGHTON
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State | MI
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Zip | 48116-1297
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Country | US
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Telephone | 567-703-0929
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Fax | 734-418-9022
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Authorized Official
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Title or Position | OWNER
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Name | ADRIAL LANTERMAN
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Credential | LMSW
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Telephone | 567-703-0929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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