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35429 Schoenherr Rd Sterling Heights MI 48312-4258 | |
| (586) 909-5031 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 35429 Schoenherr Rd, Sterling Heights, Michigan |
| Authorized Official Name and Position | Eric J Black (OWNER) |
| Authorized Official Contact | 2488776003 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
35429 Schoenherr Rd Sterling Heights MI 48312-4258 Ph: (586) 909-5031 | 35429 Schoenherr Rd Sterling Heights MI 48312-4258 Ph: (586) 909-5031 |
| NPI Number | 1629772397 |
|---|---|
| Provider Enumeration Date | 03/28/2023 |
| Last Update Date | 08/28/2023 |
| Certification Date | 08/21/2023 |
| Medicare PECOS PAC ID | 6608230115 |
|---|---|
| Medicare Enrollment ID | O20230918001873 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629772397 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Sarah J Kanaby |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558778134 PECOS PAC ID: 4688979826 Enrollment ID: I20160225000815 |
| Provider Name | Eric J Black |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1730526013 PECOS PAC ID: 8224492731 Enrollment ID: I20240111001155 |
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