MEDICARE: JOSEPH C BARKSDALE AND ASSOCIATES, LLC

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	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6801088597	OTHER	MI	SOCIAL WORK LICENSE NUMBER

General Provider Information

NPI Number	:	1801448865
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSEPH C BARKSDALE AND ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	7310 WOODWARD AVE STE 445
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48202-3168
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7310 WOODWARD AVE STE 445
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48202-3168
Country	:	US
Telephone Number	:	313-378-6315
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOSEPH BARKSDALE
Credential	:	LMSW, CAADC
Telephone Number	:	313-378-6315

Provider Enumeration Date	:	07/10/2019
Last Update Date	:	07/10/2019

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