| Deltasdh Llc | |
|
418 N Main St Ste 200 Royal Oak MI 48067-1813 | |
| (248) 336-2133 | |
| (248) 583-9414 |
| Full Name | Deltasdh Llc |
|---|---|
| Speciality | Social Worker |
| Location | 418 N Main St Ste 200, Royal Oak, Michigan |
| Authorized Official Name and Position | Tonya Lynn Mercier (OFFICE MANAGER/CLINICAL THERAPIST) |
| Authorized Official Contact | 3137251847 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Deltasdh Llc Po Box 97 Royal Oak MI 48068-0097 Ph: (313) 725-1847 | Deltasdh Llc 418 N Main St Ste 200 Royal Oak MI 48067-1813 Ph: (248) 336-2133 |
| NPI Number | 1144762121 |
|---|---|
| Provider Enumeration Date | 11/08/2016 |
| Last Update Date | 05/02/2021 |
| Certification Date | 05/02/2021 |
| Medicare PECOS PAC ID | 1254614613 |
|---|---|
| Medicare Enrollment ID | O20170208002089 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144762121 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (Michigan) | Primary |
| Provider Name | Larry M Gant |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164668703 PECOS PAC ID: 4284761925 Enrollment ID: I20100428000689 |
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