| Landmark Therapy Llc | |
|
28330 Franklin River Dr Southfield MI 48034-5479 | |
| (810) 875-9186 | |
| Not Available |
| Full Name | Landmark Therapy Llc |
|---|---|
| Speciality | Social Worker |
| Location | 28330 Franklin River Dr, Southfield, Michigan |
| Authorized Official Name and Position | James Council Wickersham (CLINICAL DIRECTOR) |
| Authorized Official Contact | 2489310016 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Landmark Therapy Llc 1848 Humphrey Ave Birmingham MI 48009-7153 Ph: (810) 875-9186 | Landmark Therapy Llc 28330 Franklin River Dr Southfield MI 48034-5479 Ph: (810) 875-9186 |
| NPI Number | 1225520133 |
|---|---|
| Provider Enumeration Date | 06/06/2018 |
| Last Update Date | 06/06/2018 |
| Medicare PECOS PAC ID | 2264785302 |
|---|---|
| Medicare Enrollment ID | O20181019000600 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225520133 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 104100000X | Social Worker | (* (Not Available)) | Primary |
| Provider Name | Cara B Clevenger |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295039667 PECOS PAC ID: 5597948232 Enrollment ID: I20110317000932 |
| Provider Name | Richard G Mastroianni |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629116181 PECOS PAC ID: 3072613082 Enrollment ID: I20131213001072 |
| Provider Name | Vaiva Varner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548691892 PECOS PAC ID: 3375846413 Enrollment ID: I20160122000999 |
| Provider Name | James Wickersham |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396106225 PECOS PAC ID: 1456635663 Enrollment ID: I20170308001067 |
| Provider Name | Deborah Jean Harrell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083713036 PECOS PAC ID: 1254654551 Enrollment ID: I20221031001680 |
| Provider Name | Kristen Leighanne Shepherd |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255831558 PECOS PAC ID: 4284005976 Enrollment ID: I20230117000443 |
| Provider Name | Sue Hakam |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942818737 PECOS PAC ID: 7719351543 Enrollment ID: I20230319000036 |
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