Provider Demographics
NPI:1750151916
Name:SALLY G BOOTH-SCHWADRON LLC
Entity type:Organization
Organization Name:SALLY G BOOTH-SCHWADRON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:G
Authorized Official - Last Name:BOOTH-SCHWADRON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:734-474-6824
Mailing Address - Street 1:PO BOX 1347
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48106-1347
Mailing Address - Country:US
Mailing Address - Phone:734-474-6824
Mailing Address - Fax:
Practice Address - Street 1:580 FOREST AVE STE 4B
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1780
Practice Address - Country:US
Practice Address - Phone:734-474-6824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty