Provider Demographics
NPI:1225554082
Name:EAST MICHIGAN ADULT THERAPY 13 LLC
Entity Type:Organization
Organization Name:EAST MICHIGAN ADULT THERAPY 13 LLC
Other - Org Name:EAST MICHIGAN ADULT THERAPY 13 LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:248-246-0906
Mailing Address - Street 1:15700 PROVIDENCE DR APT 120
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3126
Mailing Address - Country:US
Mailing Address - Phone:248-246-0906
Mailing Address - Fax:800-785-1506
Practice Address - Street 1:15700 PROVIDENCE DR APT 120
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3126
Practice Address - Country:US
Practice Address - Phone:248-246-0906
Practice Address - Fax:800-785-1506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-14
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty