| Fairsky Foundation | |
|
23231 Woodward Ave Ferndale MI 48220-1361 | |
| (248) 581-8777 | |
| (888) 975-9374 |
| Full Name | Fairsky Foundation |
|---|---|
| Speciality | Clinic/Center |
| Location | 23231 Woodward Ave, Ferndale, Michigan |
| Authorized Official Name and Position | David St. John (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2485818777 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fairsky Foundation 23231 Woodward Ave Ferndale MI 48220-1361 Ph: (248) 581-8777 | Fairsky Foundation 23231 Woodward Ave Ferndale MI 48220-1361 Ph: (248) 581-8777 |
| NPI Number | 1033595665 |
|---|---|
| Provider Enumeration Date | 08/05/2015 |
| Last Update Date | 08/23/2022 |
| Certification Date | 08/23/2022 |
| Medicare PECOS PAC ID | 2769775386 |
|---|---|
| Medicare Enrollment ID | O20160720000492 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033595665 | NPI | - | NPPES |
| CV0058149 | Medicaid | MI |
| Provider Name | Deborah Mcmillan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649311499 PECOS PAC ID: 1153370580 Enrollment ID: I20050112001020 |
| Provider Name | Shavon A Walton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760885982 PECOS PAC ID: 4082927652 Enrollment ID: I20150727000120 |
| Provider Name | Zina Mike Hasano |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1710385737 PECOS PAC ID: 7012200942 Enrollment ID: I20160729000365 |
| Provider Name | David G St John |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1760400774 PECOS PAC ID: 0648287268 Enrollment ID: I20180514001946 |
| Provider Name | Gemma Sharon Haynes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033661285 PECOS PAC ID: 0345580031 Enrollment ID: I20190315000660 |
| Provider Name | Melissa Chivis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902215445 PECOS PAC ID: 6800128422 Enrollment ID: I20191031003097 |
| Provider Name | Hannah Kay Allen-miller |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1679789804 PECOS PAC ID: 0941618052 Enrollment ID: I20210408002702 |
| Provider Name | Eric Dale Vest |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043773054 PECOS PAC ID: 1759775935 Enrollment ID: I20220304000184 |
| Provider Name | Michael Timothy Carroll |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942774054 PECOS PAC ID: 1557756350 Enrollment ID: I20220314001421 |
| Provider Name | Christopher Callan Bober |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1144599077 PECOS PAC ID: 3274926985 Enrollment ID: I20220324001188 |
| Provider Name | Catlin Sawyer Brauer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801431887 PECOS PAC ID: 6709272065 Enrollment ID: I20220413002118 |
| Provider Name | Stephanie Marie Starks |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780237834 PECOS PAC ID: 7719374735 Enrollment ID: I20220421001716 |
| Provider Name | Katherine Lynn O'connor-price |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487203550 PECOS PAC ID: 1052798394 Enrollment ID: I20220506001526 |
| Provider Name | Teresa Maria Turner |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1609165968 PECOS PAC ID: 5294113676 Enrollment ID: I20220526001912 |
| Provider Name | Kimberly Denise Sabra |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1346751310 PECOS PAC ID: 0446638829 Enrollment ID: I20220526001988 |
| Provider Name | Ayana Kafi Simmons |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1326460734 PECOS PAC ID: 4587042734 Enrollment ID: I20220601000280 |
| Provider Name | Heather Christine Filippelli |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922538099 PECOS PAC ID: 0749664522 Enrollment ID: I20220827000473 |
| Provider Name | Hilary Anne Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174100960 PECOS PAC ID: 8022481605 Enrollment ID: I20230301001960 |
| Provider Name | Sara Eden Langer Berlin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841961729 PECOS PAC ID: 4183097520 Enrollment ID: I20230306000225 |
| Provider Name | Staci Lauryn Kent |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225506371 PECOS PAC ID: 7214300359 Enrollment ID: I20230310000994 |
| Provider Name | Noel Lauren Ullery |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144837485 PECOS PAC ID: 0648637256 Enrollment ID: I20230613000431 |
| Provider Name | Ellen Sarah Shansky |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417573841 PECOS PAC ID: 0042660581 Enrollment ID: I20231227000389 |
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