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General NPI Number Information
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NPI Number | 1972972743
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Entity Type | Organization
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Legal Business Name | SELF-CARE CENTER
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Dates
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Enumeration Date | 09/22/2015
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Last Update Date | 09/22/2015
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Provider Practice Location Address
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Address Line | 640 N OLD WOODWARD AVE 301
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City | BIRMINGHAM
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State | MI
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Zip | 48009-3881
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Country | US
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Telephone | 248-564-3402
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Fax | 248-792-5464
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Provider Business Mailing Address
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Address Line | 640 N OLD WOODWARD AVE 301
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City | BIRMINGHAM
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State | MI
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Zip | 48009-3881
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Country | US
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Telephone | 248-564-3402
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Fax | 248-792-5464
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MRS. ALEXIS E. STONE
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Credential | LMSW
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Telephone | 248-761-3434
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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 | 6801094382
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License Number State | MI
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