Provider Demographics
NPI:1689156184
Name:HEULITT, MARCI
Entity type:Individual
Prefix:
First Name:MARCI
Middle Name:
Last Name:HEULITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 SCOFIELD CARLETON RD
Mailing Address - Street 2:
Mailing Address - City:CARLETON
Mailing Address - State:MI
Mailing Address - Zip Code:48117-9571
Mailing Address - Country:US
Mailing Address - Phone:734-771-0161
Mailing Address - Fax:
Practice Address - Street 1:37450 SCHOOLCRAFT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-1082
Practice Address - Country:US
Practice Address - Phone:734-771-0161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801068405104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker