Provider Demographics
NPI:1821181975
Name:BLAIR, GINGER RADD (MSW)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:RADD
Last Name:BLAIR
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35458 RAVINE BLVD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-2470
Mailing Address - Country:US
Mailing Address - Phone:313-415-1449
Mailing Address - Fax:
Practice Address - Street 1:4222 E MCNICHOLS RD STE A
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48212-1718
Practice Address - Country:US
Practice Address - Phone:313-369-1717
Practice Address - Fax:313-369-1728
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801035843101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health