MEDICARE: PROLIFIC CARE PSYCHOLOGICAL & COUNSELING SERVICES

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	163WH0200X	Home Health Registered Nurse

General Provider Information

NPI Number	:	1902621402
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROLIFIC CARE PSYCHOLOGICAL & COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	8248 MANSFIELD ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48228-1948
Country	:	US
Telephone Number	:	313-980-8288
Fax Number	:

Provider Business Practice Location Address
First Line	:	8248 MANSFIELD ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48228-1948
Country	:	US
Telephone Number	:	313-980-8288
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	APRIL JACKSON
Credential	:	COUNSELOR
Telephone Number	:	313-980-8288

Provider Enumeration Date	:	11/19/2024
Last Update Date	:	11/19/2024

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