Provider Demographics
NPI:1881309870
Name:FILLMORE, AARON JUSTIN (LMSW)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:JUSTIN
Last Name:FILLMORE
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 E 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CENTER LINE
Mailing Address - State:MI
Mailing Address - Zip Code:48015-1168
Mailing Address - Country:US
Mailing Address - Phone:586-501-3070
Mailing Address - Fax:
Practice Address - Street 1:6900 E 10 MILE RD
Practice Address - Street 2:
Practice Address - City:CENTER LINE
Practice Address - State:MI
Practice Address - Zip Code:48015
Practice Address - Country:US
Practice Address - Phone:586-501-3070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801119683104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker