Provider Demographics
NPI:1821870254
Name:EMDRMI LLC
Entity Type:Organization
Organization Name:EMDRMI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:WARE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:347-210-5373
Mailing Address - Street 1:1629 VIRGINIA PARK ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48206-2419
Mailing Address - Country:US
Mailing Address - Phone:347-210-5373
Mailing Address - Fax:
Practice Address - Street 1:1629 VIRGINIA PARK ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-2419
Practice Address - Country:US
Practice Address - Phone:347-210-5373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-19
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty