Organization
COMMON GROUND
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. HEATHER RAE MA, LLP (CEO/PRESIDENT)
(248) 456-8150
Entity
Organization
Contact information
Practice address
1200 N TELEGRAPH RD, PONTIAC, MI 48341-1032
(248) 456-3780
(248) 456-8156
Mailing address
1410 S TELEGRAPH RD, BLOOMFIELD HILLS, MI 48302-0046
(248) 451-3780
(248) 456-8153
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
70-0-F3-75555-0
BCBS
MI
Enumeration date
11/15/2006
Last updated
01/08/2018
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