Provider Demographics
NPI:1851686620
Name:EASTER SEALS OF MICHIGAN
Entity Type:Organization
Organization Name:EASTER SEALS OF MICHIGAN
Other - Org Name:COLLABORATIVE SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:STANDIFER
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPC
Authorized Official - Phone:248-706-3450
Mailing Address - Street 1:269 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-3364
Mailing Address - Country:US
Mailing Address - Phone:248-706-3450
Mailing Address - Fax:248-706-3455
Practice Address - Street 1:269 SUMMIT DR
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-3364
Practice Address - Country:US
Practice Address - Phone:248-706-3450
Practice Address - Fax:248-706-3455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009187251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health