12th Avenue Services Llc | |
5541 Warbler Dr Clarkston MI 48346-2965 | |
(248) 795-5253 | |
(248) 928-5350 |
Full Name | 12th Avenue Services Llc |
---|---|
Speciality | Counselor - Mental Health |
Location | 5541 Warbler Dr, Clarkston, Michigan |
Authorized Official Name and Position | Abigail Leigh Blackshire (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 2487955253 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
12th Avenue Services Llc 5541 Warbler Dr Clarkston MI 48346-2965 Ph: (248) 795-5253 | 12th Avenue Services Llc 5541 Warbler Dr Clarkston MI 48346-2965 Ph: (248) 795-5253 |
NPI Number | 1023879186 |
---|---|
Provider Enumeration Date | 01/17/2024 |
Last Update Date | 01/17/2024 |
Certification Date | 01/17/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1023879186 | NPI | - | NPPES |
1285110288 | Medicaid | AK |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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