| 12th Avenue Services Llc | |
|
5541 Warbler Dr Clarkston MI 48346-2965 | |
| (248) 795-5253 | |
| (248) 928-5350 |
| Full Name | 12th Avenue Services Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 5541 Warbler Dr, Clarkston, Michigan |
| Authorized Official Name and Position | Abigail Leigh Blackshire (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 2487955253 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 12th Avenue Services Llc 5541 Warbler Dr Clarkston MI 48346-2965 Ph: (248) 795-5253 | 12th Avenue Services Llc 5541 Warbler Dr Clarkston MI 48346-2965 Ph: (248) 795-5253 |
| NPI Number | 1023879186 |
|---|---|
| Provider Enumeration Date | 01/17/2024 |
| Last Update Date | 01/17/2024 |
| Certification Date | 01/17/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023879186 | NPI | - | NPPES |
| 1285110288 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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