MEDICARE: WILBART FAMILY SERVICES 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	104100000X	Social Worker
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1922572056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILBART FAMILY SERVICES LLC

Provider Business Mailing Address
First Line	:	1420 WASHINGTON BLVD STE 301
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48226-1718
Country	:	US
Telephone Number	:	888-832-4132
Fax Number	:	855-343-8820

Provider Business Practice Location Address
First Line	:	1420 WASHINGTON BLVD STE 301
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48226-1718
Country	:	US
Telephone Number	:	888-832-4132
Fax Number	:	855-343-8820

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID WILLIAMS
Credential	:
Telephone Number	:	888-832-4132

Provider Enumeration Date	:	01/11/2019
Last Update Date	:	01/11/2019

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