Provider Demographics
NPI:1316351992
Name:LIFELINE CENTER, PLLC
Entity type:Organization
Organization Name:LIFELINE CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERITA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:586-343-2154
Mailing Address - Street 1:PO BOX 216
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48094-0216
Mailing Address - Country:US
Mailing Address - Phone:888-910-9922
Mailing Address - Fax:
Practice Address - Street 1:41800 HAYES RD
Practice Address - Street 2:SUITE 208
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1876
Practice Address - Country:US
Practice Address - Phone:888-910-9922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-11
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MI6801096616251B00000X, 251E00000X, 251K00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty
No251E00000XAgenciesHome Health
No251K00000XAgenciesPublic Health or Welfare