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General NPI Number Information
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NPI Number | 1750151916
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Entity Type | Organization
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Legal Business Name | SALLY G BOOTH-SCHWADRON LLC
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Dates
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Enumeration Date | 01/08/2024
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Last Update Date | 01/08/2024
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Provider Practice Location Address
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Address Line | 580 FOREST AVE STE 4B
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City | PLYMOUTH
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State | MI
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Zip | 48170-1780
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Country | US
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Telephone | 734-474-6824
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1347
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City | ANN ARBOR
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State | MI
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Zip | 48106-1347
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Country | US
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Telephone | 734-474-6824
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | SALLY G BOOTH-SCHWADRON
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Credential | LMSW
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Telephone | 734-474-6824
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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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