Organization
ASCENSION PROVIDENCE HOSPITAL
Active
Other names
PH Psychology PhD/Providence Hospital and Medical Centers Inc
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH STARKEL (CREDENTIALING COORDINATOR)
(248) 680-8121
Entity
Organization
Contact information
Practice address
16001 W 9 MILE RD, SOUTHFIELD, MI 48075-4818
(248) 849-3000
(248) 849-2244
Mailing address
28000 DEQUINDRE RD, WARREN, MI 48092-2468
(248) 680-8000
(248) 292-3852
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
680F371930
MI BLUE CROSS GROUP PIN #
MI
Enumeration date
04/20/2006
Last updated
06/28/2022
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