Provider Demographics
NPI:1669596300
Name:BLUMERICK, MARIKA (CAC1)
Entity type:Individual
Prefix:MRS
First Name:MARIKA
Middle Name:
Last Name:BLUMERICK
Suffix:
Gender:F
Credentials:CAC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51284 MOROWSKE DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-4623
Mailing Address - Country:US
Mailing Address - Phone:248-547-2223
Mailing Address - Fax:248-547-2226
Practice Address - Street 1:1400 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-2651
Practice Address - Country:US
Practice Address - Phone:248-547-2223
Practice Address - Fax:248-547-2226
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-00126101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1-00126OtherCERTIFIED ADDICTIONS COUN