Provider Demographics
NPI:1790795946
Name:SOKA SERVICES
Entity Type:Organization
Organization Name:SOKA SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHALON
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW ACSW CFAE
Authorized Official - Phone:248-451-0540
Mailing Address - Street 1:PO BOX 250693
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48325-0693
Mailing Address - Country:US
Mailing Address - Phone:248-356-0540
Mailing Address - Fax:248-356-0539
Practice Address - Street 1:22511 TELEGRAPH RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-4115
Practice Address - Country:US
Practice Address - Phone:248-356-0540
Practice Address - Fax:248-356-0539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
800F323610OtherBLUE CROSS BLUE SHIELD
DC6241OtherMEDICARE RAILROAD
DC6241OtherMEDICARE RAILROAD