| Loretta Bantom, | |
|
79 W Alexandrine St, Detroit, MI 48201-2015 | |
| (313) 831-5535 | |
| (313) 831-2608 |
| Full Name | Loretta Bantom |
|---|---|
| Gender | Female |
| Speciality | Counselor - Professional |
| Location | 79 W Alexandrine St, Detroit, Michigan |
| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013448059 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 6401015420 (Michigan) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Loretta Bantom, 79 W Alexandrine St, Detroit, MI 48201-2015 Ph: (313) 831-5535 | Loretta Bantom, 79 W Alexandrine St, Detroit, MI 48201-2015 Ph: (313) 831-5535 |
Anthony Jerome Allen, AAS., CAC II Counselor Medicare: Not Enrolled in Medicare Practice Location: 12010 Linwood St, Detroit, MI 48206 Phone: 313-867-1090 Fax: 313-867-0706 | |
Mr. Brian R Cogliati, Counselor Medicare: Not Enrolled in Medicare Practice Location: 1852 W Grand Blvd, 1852 W. Grand Blvd, Detroit, MI 48208 Phone: 313-894-8444 Fax: 313-894-5542 | |
Mr. Gregory Charles Guice, MA Counselor Medicare: Not Enrolled in Medicare Practice Location: 1151 Taylor Ave., Detroit, MI 48202 Phone: 313-874-8715 | |
Ms. Carol Potter, MA, BCBA, LBA Counselor Medicare: Not Enrolled in Medicare Practice Location: 2200 Hunt St, Detroit, MI 48207 Phone: 248-537-2516 | |
Mrs. Lisa Polk-woolfolk, MS, LLPC, CAC-M Counselor Medicare: Not Enrolled in Medicare Practice Location: 3731 Rivard St, Detroit, MI 48207 Phone: 313-258-9713 | |
Alicia Monique Lurry, LPC Counselor Medicare: Medicare Enrolled Practice Location: 8171 Parkland, Detroit, MI 48239 Phone: 313-282-7567 | |
Mr. Darren Kilgore, Counselor Medicare: Not Enrolled in Medicare Practice Location: 269 Walker St, 538, Detroit, MI 48207 Phone: 313-610-0134 |