Provider Demographics
NPI:1487358164
Name:PLOTZKE, ELAINE TERESE (LMSW, ACSW)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:TERESE
Last Name:PLOTZKE
Suffix:
Gender:F
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37899 W 12 MILE RD STE 250
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-6107
Mailing Address - Country:US
Mailing Address - Phone:248-921-4614
Mailing Address - Fax:
Practice Address - Street 1:37899 W 12 MILE RD STE 250
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-6107
Practice Address - Country:US
Practice Address - Phone:248-921-4614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010630491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty