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2425 S Linden Rd Ste D138 Flint MI 48532-5482 | |
| (810) 339-6942 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 2425 S Linden Rd Ste D138, Flint, Michigan |
| Authorized Official Name and Position | Tasheikya Hunter (OWNER) |
| Authorized Official Contact | 8103396942 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2425 S Linden Rd Ste D138 Flint MI 48532-5482 Ph: (810) 339-6942 | 2425 S Linden Rd Ste D138 Flint MI 48532-5482 Ph: (810) 339-6942 |
| NPI Number | 1518664069 |
|---|---|
| Provider Enumeration Date | 02/14/2023 |
| Last Update Date | 11/21/2023 |
| Certification Date | 11/21/2023 |
| Medicare PECOS PAC ID | 6901130483 |
|---|---|
| Medicare Enrollment ID | O20230321000144 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518664069 | NPI | - | NPPES |
| Provider Name | Robert E Ennis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063793594 PECOS PAC ID: 0941447080 Enrollment ID: I20130625000313 |
| Provider Name | Ayana Fordham |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326285156 PECOS PAC ID: 4385987213 Enrollment ID: I20190516002373 |
| Provider Name | Cynthia Pearl Mannino |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518267434 PECOS PAC ID: 9739545120 Enrollment ID: I20230509001774 |
| Provider Name | Sequida Cooper |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1346373776 PECOS PAC ID: 6507294618 Enrollment ID: I20240329001856 |
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