Individual
AZELDRI VAN DER WATH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
888 W BIG BEAVER RD STE 780, TROY, MI 48084-4745
(248) 215-2716
Mailing address
888 W BIG BEAVER RD STE 780, TROY, MI 48084-4745
(248) 215-2716
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6801106710
MI
Other
Enumeration date
11/05/2020
Last updated
02/11/2022
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