12Th Avenue Services Llc

LBN: 12Th Avenue Services Llc
12Th Avenue Services Llc is an health care organization with primary practice located at 5541 Warbler Dr , Clarkston MI 48346-2965. The organization recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as the primary health care specialty. 12Th Avenue Services Llc can be contacted via phone (248) 795-5253, or through Blackshire, Abigail Leigh via phone (248) 795-5253.

Contact Information

Primary practice address
5541 Warbler Dr Clarkston MI 48346-2965
Phone: (248) 795-5253
Fax: (248) 928-5350
Website:
Map and Directions
Authorized official contact:
Name: Blackshire, Abigail Leigh Licensed Professional Counselor (LPC)
Phone: (248) 795-5253

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X

Profile Details

NPI number 1023879186
LBN Legal business name 12Th Avenue Services Llc
DBA Doing business as
Authorized official Blackshire, Abigail Leigh Licensed Professional Counselor (LPC)
Entity Organization
Organization subpart 1 No
Enumeration date Jan 17th, 2024
Last updated Jan 17th, 2024 - about 2 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1023879186 NPPES
Alaska MEDICAID 1285110288

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