| Nso | |
|
882 Oakman Blvd Ste. C Detroit MI 48238-3710 | |
| (313) 961-4890 | |
| (313) 867-3675 |
| Full Name | Nso |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 882 Oakman Blvd, Detroit, Michigan |
| Authorized Official Name and Position | Linda Joyce Little (PRESIDENT & CEO) |
| Authorized Official Contact | 3139614890 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nso 882 Oakman Blvd Ste. C Detroit MI 48238-3710 Ph: (313) 961-4890 | Nso 882 Oakman Blvd Ste. C Detroit MI 48238-3710 Ph: (313) 961-4890 |
| NPI Number | 1891825808 |
|---|---|
| Provider Enumeration Date | 03/07/2007 |
| Last Update Date | 04/15/2020 |
| Certification Date | 04/15/2020 |
| Medicare PECOS PAC ID | 7113907387 |
|---|---|
| Medicare Enrollment ID | O20040720001455 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891825808 | NPI | - | NPPES |
| 3273262 | Medicaid | MI | |
| 3273370 | Medicaid | MI | |
| 4161019 | Medicaid | MI | |
| 4373960 | Medicaid | MI | |
| 4512769 | Medicaid | MI | |
| 4678149 | Medicaid | MI | |
| 0P03970 | Other | MI | MEDICARE PIN NUMBER |
| 3273271 | Medicaid | MI | |
| 600501 | Other | MI | CONSUMERLINK PROVIDER NUM |
| 3273280 | Medicaid | MI | |
| 4465471 | Medicaid | MI | |
| 4675817 | Medicaid | MI | |
| 4652438 | Medicaid | MI | |
| 053720 | Other | MI | CARELINK PROVIDER NUMBER |
| 13493 | Other | MI | DETROIT WAYNE ID NUMBER |
| 669973 | Other | MI | CONSUMERLINK PROVIDER NUM |
| 3273315 | Medicaid | MI | |
| 4354472 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (Michigan) | Primary |
| Provider Name | Richard C Marcolini |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1265577571 PECOS PAC ID: 5597740514 Enrollment ID: I20040623000016 |
| Provider Name | Gregory J Allen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619198603 PECOS PAC ID: 0941288872 Enrollment ID: I20040708000700 |
| Provider Name | Abdul Rauf |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1417994906 PECOS PAC ID: 0840262085 Enrollment ID: I20040809001238 |
| Provider Name | Nadimpalli V Raju |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1700834827 PECOS PAC ID: 3274599832 Enrollment ID: I20041206000281 |
| Provider Name | Lisa Renee Haston-fuller |
|---|---|
| Provider Type | Practitioner - Geriatric Psychiatry |
| Provider Identifiers | NPI Number: 1831298397 PECOS PAC ID: 3870549355 Enrollment ID: I20050328000951 |
| Provider Name | Katrina Denise Richardson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053399337 PECOS PAC ID: 2961423173 Enrollment ID: I20051215000641 |
| Provider Name | Alireza Amirsadri |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1457398059 PECOS PAC ID: 4082515564 Enrollment ID: I20060630000137 |
| Provider Name | Shahid Hussain |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1396783452 PECOS PAC ID: 5597778746 Enrollment ID: I20060711000219 |
| Provider Name | Karen L Boyd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386642791 PECOS PAC ID: 1951303155 Enrollment ID: I20070131000569 |
| Provider Name | Cheryl A Fregolle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477598696 PECOS PAC ID: 9638248693 Enrollment ID: I20080516000023 |
| Provider Name | Lubna S Izzathullah |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1730372228 PECOS PAC ID: 6800983248 Enrollment ID: I20090622000587 |
| Provider Name | Elizabeth J Eldon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1285758755 PECOS PAC ID: 6204961527 Enrollment ID: I20100311000911 |
| Provider Name | Kathiravelu Thabolingam |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1932167814 PECOS PAC ID: 3375739360 Enrollment ID: I20101202000835 |
| Provider Name | Doresea Lewis-bogan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124218466 PECOS PAC ID: 7315182979 Enrollment ID: I20130402000289 |
| Provider Name | Blaine G Burks |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174632145 PECOS PAC ID: 1557463064 Enrollment ID: I20130417000143 |
| Provider Name | Bardia Gholami |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316079270 PECOS PAC ID: 5698903235 Enrollment ID: I20140106001083 |
| Provider Name | Carmen R Serpa |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1710298674 PECOS PAC ID: 0446479299 Enrollment ID: I20140910001122 |
| Provider Name | Julie Collins-marquez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376941047 PECOS PAC ID: 6305160540 Enrollment ID: I20150119000354 |
| Provider Name | Chinwe Prisca Ohaka |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700226875 PECOS PAC ID: 9436453685 Enrollment ID: I20160208001937 |
| Provider Name | Pasha M Streeter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922322684 PECOS PAC ID: 4385874015 Enrollment ID: I20160615000985 |
| Provider Name | Gayle J Hatfield |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942416821 PECOS PAC ID: 4688962301 Enrollment ID: I20161013000299 |
| Provider Name | Candace Weaver |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619320538 PECOS PAC ID: 3173898954 Enrollment ID: I20171004001116 |
| Provider Name | Eddia M Mcdade |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942685607 PECOS PAC ID: 3375818081 Enrollment ID: I20171005002728 |
| Provider Name | Rascha Azakir |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073026944 PECOS PAC ID: 6709146624 Enrollment ID: I20180213003087 |
| Provider Name | Gregory Samuel Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558732586 PECOS PAC ID: 8628326774 Enrollment ID: I20180806001420 |
| Provider Name | Melissa Matkovich |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689125197 PECOS PAC ID: 2567705775 Enrollment ID: I20190509002346 |
| Provider Name | Tracey L Green |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295136729 PECOS PAC ID: 7810226065 Enrollment ID: I20190912002483 |
| Provider Name | Judy Claire Paull |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568905081 PECOS PAC ID: 1254483191 Enrollment ID: I20200218002283 |
| Provider Name | Kristal Reyes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417339201 PECOS PAC ID: 6507289972 Enrollment ID: I20200702001391 |
| Provider Name | Makula Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942813712 PECOS PAC ID: 0941586457 Enrollment ID: I20201125001965 |
| Provider Name | Audrey Lee Jackson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093237943 PECOS PAC ID: 6204240427 Enrollment ID: I20210129002230 |
| Provider Name | Yanyan Wang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043806045 PECOS PAC ID: 8022422864 Enrollment ID: I20210205001699 |
| Provider Name | Tiffany Denise Washington |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407006745 PECOS PAC ID: 4789088311 Enrollment ID: I20210804002492 |
| Provider Name | Jaleesa Pouncil |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376167460 PECOS PAC ID: 7517362064 Enrollment ID: I20210820001132 |
| Provider Name | Aum Aeeman Memon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740711605 PECOS PAC ID: 0345599239 Enrollment ID: I20211022002401 |
| Provider Name | Erin Lyons |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598370355 PECOS PAC ID: 0143602839 Enrollment ID: I20220727002413 |
| Provider Name | Omar Soubani |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255995346 PECOS PAC ID: 3779816574 Enrollment ID: I20220815001703 |
| Provider Name | Sherry A Webster |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700142841 PECOS PAC ID: 3779728118 Enrollment ID: I20221206001845 |
| Provider Name | Samantha Teach |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366047250 PECOS PAC ID: 1052782992 Enrollment ID: I20230201000135 |
| Provider Name | Ranya Al-jamal |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154892008 PECOS PAC ID: 0042684029 Enrollment ID: I20230314001160 |
| Provider Name | Kelly Minor |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699122721 PECOS PAC ID: 5698054807 Enrollment ID: I20230314001366 |
| Provider Name | Joseph Arocho |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851746838 PECOS PAC ID: 4284008863 Enrollment ID: I20230322000711 |
| Provider Name | Jennifer Bardon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629623541 PECOS PAC ID: 7315312832 Enrollment ID: I20230413002086 |
| Provider Name | Emily Wiese |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073114260 PECOS PAC ID: 8820453327 Enrollment ID: I20230506000320 |
| Provider Name | William Wilson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205479052 PECOS PAC ID: 3375909294 Enrollment ID: I20230519000688 |
| Provider Name | Lindsay Fernandez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518403575 PECOS PAC ID: 3274999040 Enrollment ID: I20230520000279 |
| Provider Name | Ashley Schumaker |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1083174460 PECOS PAC ID: 6800122615 Enrollment ID: I20230711002800 |
| Provider Name | Jennifer Lembesis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265861660 PECOS PAC ID: 2961865068 Enrollment ID: I20230822003160 |
| Provider Name | Marin Drouillard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336516525 PECOS PAC ID: 3971958414 Enrollment ID: I20231018002113 |
| Provider Name | Jessica Williams |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538799754 PECOS PAC ID: 1052764875 Enrollment ID: I20240129002097 |
| Provider Name | Cheri Fritzley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841071743 PECOS PAC ID: 5496193773 Enrollment ID: I20240405000427 |
| Provider Name | Amanda Estioco |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447854112 PECOS PAC ID: 6608318183 Enrollment ID: I20240612001742 |
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