Provider Demographics
NPI:1225333032
Name:ELISSA RUTH DRIKER LMSW LLC
Entity Type:Organization
Organization Name:ELISSA RUTH DRIKER LMSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:DRIKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-376-5330
Mailing Address - Street 1:628 E PARENT AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-3765
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:628 E PARENT AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-3765
Practice Address - Country:US
Practice Address - Phone:248-376-5330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010670681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty