Provider Demographics
NPI:1932516184
Name:SUPPORT MANAGEMENT SERVICES, LLC
Entity Type:Organization
Organization Name:SUPPORT MANAGEMENT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:STAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-266-6800
Mailing Address - Street 1:32231 SCHOOLCRAFT RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-4312
Mailing Address - Country:US
Mailing Address - Phone:734-266-6800
Mailing Address - Fax:
Practice Address - Street 1:32231 SCHOOLCRAFT RD
Practice Address - Street 2:SUITE 210
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-4312
Practice Address - Country:US
Practice Address - Phone:734-266-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251K00000X
MI6801019488251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health