Basic Information
| Provider Information | |||||||||
| NPI: | 1417561291 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEBB | ||||||||
| FirstName: | MICAH | ||||||||
| MiddleName: | MACHEE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LLBSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24710 WESTHAMPTON ST | ||||||||
| Address2: | |||||||||
| City: | OAK PARK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482374029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3136760038 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 13336 E WARREN AVE | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482152112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138226940 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2020 | ||||||||
| LastUpdateDate: | 08/31/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6802090646 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.