Provider Demographics
NPI:1952510182
Name:HENRY FORD HEALTH SYSTEM MAPLEGROVE CENTER
Entity Type:Organization
Organization Name:HENRY FORD HEALTH SYSTEM MAPLEGROVE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL HEALTH THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:SEKULICH
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:248-788-3018
Mailing Address - Street 1:6773 W MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3013
Mailing Address - Country:US
Mailing Address - Phone:248-661-6100
Mailing Address - Fax:248-788-3177
Practice Address - Street 1:6773 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3013
Practice Address - Country:US
Practice Address - Phone:248-661-6100
Practice Address - Fax:248-788-3177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801086544261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder