Provider Demographics
NPI:1396360343
Name:ANDREA ATWELL
Entity Type:Organization
Organization Name:ANDREA ATWELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOLLY
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-343-3249
Mailing Address - Street 1:6037 MAYFAIR ST
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-1360
Mailing Address - Country:US
Mailing Address - Phone:313-242-7326
Mailing Address - Fax:313-499-9395
Practice Address - Street 1:6037 MAYFAIR ST
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-1360
Practice Address - Country:US
Practice Address - Phone:313-242-7326
Practice Address - Fax:313-499-9395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty