Provider Demographics
NPI:1972972743
Name:SELF-CARE CENTER
Entity Type:Organization
Organization Name:SELF-CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:248-761-3434
Mailing Address - Street 1:640 N OLD WOODWARD AVE
Mailing Address - Street 2:301
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-3881
Mailing Address - Country:US
Mailing Address - Phone:248-564-3402
Mailing Address - Fax:248-792-5464
Practice Address - Street 1:640 N OLD WOODWARD AVE
Practice Address - Street 2:301
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-3881
Practice Address - Country:US
Practice Address - Phone:248-564-3402
Practice Address - Fax:248-792-5464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010943821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty