Basic Information
| Provider Information | |||||||||
| NPI: | 1962975631 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | URBAIN | ||||||||
| FirstName: | EMMA | ||||||||
| MiddleName: | JEAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3552 PHEASANT RUN CIR APT 4 | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481082469 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173582254 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5716 MICHIGAN AVE | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482103039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3136251336 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2019 | ||||||||
| LastUpdateDate: | 01/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.