Basic Information
| Provider Information | |||||||||
| NPI: | 1861406282 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARLAND | ||||||||
| FirstName: | COLLEEN | ||||||||
| MiddleName: | FISH | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 20646 | ||||||||
| Address2: | |||||||||
| City: | FERNDALE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482200646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3135065562 | ||||||||
| FaxNumber: | 7347284278 | ||||||||
| Practice Location | |||||||||
| Address1: | 8230 E FOREST AVE | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482141156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3139240085 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 06/21/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801020481 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.