| East Michigan Adult Therapy 13 Llc | |
|
15700 Providence Dr Apt 120 Southfield MI 48075-3126 | |
| (248) 246-0906 | |
| (800) 785-1506 |
| Full Name | East Michigan Adult Therapy 13 Llc |
|---|---|
| Speciality | Social Worker |
| Location | 15700 Providence Dr Apt 120, Southfield, Michigan |
| Authorized Official Name and Position | Melanie Nicole Davis (OWNER) |
| Authorized Official Contact | 2482460906 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| East Michigan Adult Therapy 13 Llc 15700 Providence Dr Apt 120 Southfield MI 48075-3126 Ph: (248) 246-0906 | East Michigan Adult Therapy 13 Llc 15700 Providence Dr Apt 120 Southfield MI 48075-3126 Ph: (248) 246-0906 |
| NPI Number | 1225554082 |
|---|---|
| Provider Enumeration Date | 08/14/2017 |
| Last Update Date | 02/10/2023 |
| Certification Date | 02/10/2023 |
| Medicare PECOS PAC ID | 0648532457 |
|---|---|
| Medicare Enrollment ID | O20180314001669 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225554082 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (Michigan) | Primary |
| Provider Name | Cynthia D Muhammad |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326489212 PECOS PAC ID: 6901031129 Enrollment ID: I20131024000753 |
| Provider Name | Melonie Barnes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447793245 PECOS PAC ID: 3577846609 Enrollment ID: I20170215000501 |
| Provider Name | Jacqueline Holt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952825713 PECOS PAC ID: 3072888304 Enrollment ID: I20171012000198 |
| Provider Name | Cathy Louis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427314699 PECOS PAC ID: 8820364003 Enrollment ID: I20171017001528 |
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