MEDICARE: SARITA ADELLE WITHERSPOON LLBSW,QMRP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	6802087621	MI

General Provider Information

NPI Number	:	1083036503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARITA ADELLE WITHERSPOON LLBSW,QMRP

Provider Business Mailing Address
First Line	:	19940 RYAN RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48234-1926
Country	:	US
Telephone Number	:	313-586-2781
Fax Number	:

Provider Business Practice Location Address
First Line	:	19940 RYAN RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48234-1926
Country	:	US
Telephone Number	:	313-586-2781
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2014
Last Update Date	:	01/17/2014

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