Provider Demographics
NPI:1699002907
Name:FAUSTINIA LOPER, CSW, PC
Entity Type:Organization
Organization Name:FAUSTINIA LOPER, CSW, PC
Other - Org Name:FAUSTINIA LOPER, ACSW, LMSW, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FAUSTINIA
Authorized Official - Middle Name:TALISON
Authorized Official - Last Name:LOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:248-358-6780
Mailing Address - Street 1:17515 W 9 MILE RD
Mailing Address - Street 2:SUITE 375
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4403
Mailing Address - Country:US
Mailing Address - Phone:248-358-6780
Mailing Address - Fax:248-358-6780
Practice Address - Street 1:17515 W 9 MILE RD
Practice Address - Street 2:SUITE 375
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4403
Practice Address - Country:US
Practice Address - Phone:248-358-6780
Practice Address - Fax:248-358-6780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-06
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801014838251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health