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General NPI Number Information
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NPI Number | 1932516184
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Entity Type | Organization
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Legal Business Name | SUPPORT MANAGEMENT SERVICES, LLC
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Dates
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Enumeration Date | 07/21/2014
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Last Update Date | 07/21/2014
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Provider Practice Location Address
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Address Line | 32231 SCHOOLCRAFT RD SUITE 210
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City | LIVONIA
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State | MI
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Zip | 48150-4312
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Country | US
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Telephone | 734-266-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 32231 SCHOOLCRAFT RD SUITE 210
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City | LIVONIA
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State | MI
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Zip | 48150-4312
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Country | US
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Telephone | 734-266-6800
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | VANESSA STAFFORD
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Credential |
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Telephone | 734-266-6800
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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 | 6801019488
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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