| Nso | |
|
882 Oakman Blvd Ste. C Detroit MI 48238-3710 | |
| (313) 961-4890 | |
| (313) 867-3675 |
| Full Name | Nso |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 882 Oakman Blvd, Detroit, Michigan |
| Authorized Official Name and Position | Linda Joyce Little (PRESIDENT & CEO) |
| Authorized Official Contact | 3139614890 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nso 882 Oakman Blvd Ste. C Detroit MI 48238-3710 Ph: (313) 961-4890 | Nso 882 Oakman Blvd Ste. C Detroit MI 48238-3710 Ph: (313) 961-4890 |
| NPI Number | 1891825808 |
|---|---|
| Provider Enumeration Date | 03/07/2007 |
| Last Update Date | 04/15/2020 |
| Certification Date | 04/15/2020 |
| Medicare PECOS PAC ID | 7113907387 |
|---|---|
| Medicare Enrollment ID | O20040720001455 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891825808 | NPI | - | NPPES |
| 3273262 | Medicaid | MI | |
| 3273370 | Medicaid | MI | |
| 4161019 | Medicaid | MI | |
| 4373960 | Medicaid | MI | |
| 4512769 | Medicaid | MI | |
| 4678149 | Medicaid | MI | |
| 0P03970 | Other | MI | MEDICARE PIN NUMBER |
| 3273271 | Medicaid | MI | |
| 600501 | Other | MI | CONSUMERLINK PROVIDER NUM |
| 3273280 | Medicaid | MI | |
| 4465471 | Medicaid | MI | |
| 4675817 | Medicaid | MI | |
| 4652438 | Medicaid | MI | |
| 053720 | Other | MI | CARELINK PROVIDER NUMBER |
| 13493 | Other | MI | DETROIT WAYNE ID NUMBER |
| 669973 | Other | MI | CONSUMERLINK PROVIDER NUM |
| 3273315 | Medicaid | MI | |
| 4354472 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (Michigan) | Primary |
| Provider Name | Abdul Rauf |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1417994906 PECOS PAC ID: 0840262085 Enrollment ID: I20040809001238 |
| Provider Name | Nadimpalli V Raju |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1700834827 PECOS PAC ID: 3274599832 Enrollment ID: I20041206000281 |
| Provider Name | Lisa Renee Haston-fuller |
|---|---|
| Provider Type | Practitioner - Geriatric Psychiatry |
| Provider Identifiers | NPI Number: 1831298397 PECOS PAC ID: 3870549355 Enrollment ID: I20050328000951 |
| Provider Name | Katrina Denise Richardson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053399337 PECOS PAC ID: 2961423173 Enrollment ID: I20051215000641 |
| Provider Name | Alireza Amirsadri |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1457398059 PECOS PAC ID: 4082515564 Enrollment ID: I20060630000137 |
| Provider Name | Shahid Hussain |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1396783452 PECOS PAC ID: 5597778746 Enrollment ID: I20060711000219 |
| Provider Name | Karen L Boyd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386642791 PECOS PAC ID: 1951303155 Enrollment ID: I20070131000569 |
| Provider Name | Cheryl a Fregolle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477598696 PECOS PAC ID: 9638248693 Enrollment ID: I20080516000023 |
| Provider Name | Lubna S Izzathullah |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1730372228 PECOS PAC ID: 6800983248 Enrollment ID: I20090622000587 |
| Provider Name | Doresea Lewis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124218466 PECOS PAC ID: 7315182979 Enrollment ID: I20130402000289 |
| Provider Name | Blaine G Burks |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174632145 PECOS PAC ID: 1557463064 Enrollment ID: I20130417000143 |
| Provider Name | Bardia Gholami |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316079270 PECOS PAC ID: 5698903235 Enrollment ID: I20140106001083 |
| Provider Name | Julie Collins-marquez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376941047 PECOS PAC ID: 6305160540 Enrollment ID: I20150119000354 |
| Provider Name | Sheba T Blanding |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568808517 PECOS PAC ID: 9830402361 Enrollment ID: I20150713002421 |
| Provider Name | Chinwe Prisca Ohaka |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700226875 PECOS PAC ID: 9436453685 Enrollment ID: I20160208001937 |
| Provider Name | Pasha M Streeter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922322684 PECOS PAC ID: 4385874015 Enrollment ID: I20160615000985 |
| Provider Name | Gayle J Hatfield |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942416821 PECOS PAC ID: 4688962301 Enrollment ID: I20161013000299 |
| Provider Name | Gregory Samuel Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558732586 PECOS PAC ID: 8628326774 Enrollment ID: I20180806001420 |
| Provider Name | Kimberly R Varga |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508316100 PECOS PAC ID: 1456690700 Enrollment ID: I20190304001052 |
| Provider Name | Jasmine L Bullock |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528523842 PECOS PAC ID: 6709126394 Enrollment ID: I20190318002356 |
| Provider Name | Tracey L Green |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295136729 PECOS PAC ID: 7810226065 Enrollment ID: I20190912002483 |
| Provider Name | Judy Claire Paull |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568905081 PECOS PAC ID: 1254483191 Enrollment ID: I20200218002283 |
| Provider Name | Kristal Reyes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417339201 PECOS PAC ID: 6507289972 Enrollment ID: I20200702001391 |
| Provider Name | Makula Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942813712 PECOS PAC ID: 0941586457 Enrollment ID: I20201125001965 |
| Provider Name | Audrey Lee Jackson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093237943 PECOS PAC ID: 6204240427 Enrollment ID: I20210129002230 |
| Provider Name | Yanyan Wang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043806045 PECOS PAC ID: 8022422864 Enrollment ID: I20210205001699 |
| Provider Name | Jessica Billups |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356810030 PECOS PAC ID: 0941604078 Enrollment ID: I20210811001118 |
| Provider Name | Jaleesa Pouncil |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376167460 PECOS PAC ID: 7517362064 Enrollment ID: I20210820001132 |
| Provider Name | Aum Aeeman Memon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740711605 PECOS PAC ID: 0345599239 Enrollment ID: I20211022002401 |
| Provider Name | Erin Lyons |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598370355 PECOS PAC ID: 0143602839 Enrollment ID: I20220727002413 |
| Provider Name | Omar Soubani |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255995346 PECOS PAC ID: 3779816574 Enrollment ID: I20220815001703 |
| Provider Name | Daria Datnoff |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356957070 PECOS PAC ID: 8123426640 Enrollment ID: I20221018002495 |
| Provider Name | Sherry a Webster |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700142841 PECOS PAC ID: 3779728118 Enrollment ID: I20221206001845 |
| Provider Name | Samantha Teach |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366047250 PECOS PAC ID: 1052782992 Enrollment ID: I20230201000135 |
| Provider Name | Kelly Minor |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699122721 PECOS PAC ID: 5698054807 Enrollment ID: I20230314001366 |
| Provider Name | Jennifer Bardon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629623541 PECOS PAC ID: 7315312832 Enrollment ID: I20230413002086 |
| Provider Name | Emily Wiese |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073114260 PECOS PAC ID: 8820453327 Enrollment ID: I20230506000320 |
| Provider Name | Lindsay Fernandez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518403575 PECOS PAC ID: 3274999040 Enrollment ID: I20230520000279 |
| Provider Name | Ashley Schumaker |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1083174460 PECOS PAC ID: 6800122615 Enrollment ID: I20230711002800 |
| Provider Name | Serena a Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457026247 PECOS PAC ID: 9335589076 Enrollment ID: I20240429003038 |
| Provider Name | Amanda Estioco |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447854112 PECOS PAC ID: 6608318183 Enrollment ID: I20240612001742 |
| Provider Name | Michele Tucker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619576378 PECOS PAC ID: 3274070123 Enrollment ID: I20240808004301 |
| Provider Name | Leigh Wayna |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083708614 PECOS PAC ID: 6204374986 Enrollment ID: I20240926000746 |
| Provider Name | Deana Judith Couch |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1487999736 PECOS PAC ID: 6204378029 Enrollment ID: I20241211002365 |
| Provider Name | Brandy Pass |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1376788984 PECOS PAC ID: 0244767069 Enrollment ID: I20241218001173 |
| Provider Name | Abdurrahman Pasha |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609351691 PECOS PAC ID: 9931563509 Enrollment ID: I20250211003741 |
| Provider Name | Andrea Sims |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609515071 PECOS PAC ID: 5193255784 Enrollment ID: I20250221001373 |
| Provider Name | India Young |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902496003 PECOS PAC ID: 7214427442 Enrollment ID: I20251106002915 |
| Provider Name | Natalee Shamie |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487436218 PECOS PAC ID: 6709360324 Enrollment ID: I20260323000647 |
| Provider Name | Autumn Whiteside |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265105878 PECOS PAC ID: 5193293264 Enrollment ID: I20260506003585 |
Bjc Counseling and Behavioral Services LLC Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 16175 Asbury Park, Detroit, MI 48235 Phone: 313-673-1992 |
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Community Social Services of Wayne County Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 9851 Hamilton Ave, Detroit, MI 48202 Phone: 313-883-2339 Fax: 313-883-3957 |
Emanuel T. Vanbolden, PhD, LP, PC Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 60 Farnsworth St, Detroit, MI 48202 Phone: 313-577-2840 Fax: 313-577-8949 |
Mindful Synergy Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 19120 Grand River Ave, Detroit, MI 48223 Phone: 313-999-3659 |