OrganizationActive
Adult & Family Services
NPI 1720130461 · Clinical Social Worker · Southgate, MI
Provider details
- NPI number
- 1720130461
- Entity type
- Organization
- Primary specialty
- Clinical Social WorkerBehavioral Health & Social Service Providers
- Authorized official
- Mark Small, Supervisor
- License
- 6801060222 (MI)
Mailing address
19291 Northline Rd
Southgate, MI 48195-2220
Registry dates
- Enumerated
- 2007-01-16
- Last updated
- 2008-06-16
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.