Provider Demographics
NPI:1992493084
Name:RAICEVICH, CHRISTA (LLMSW)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:
Last Name:RAICEVICH
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40500 ANN ARBOR RD E STE 200A
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-4498
Mailing Address - Country:US
Mailing Address - Phone:734-666-5094
Mailing Address - Fax:
Practice Address - Street 1:40500 ANN ARBOR RD E STE 200A
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-4498
Practice Address - Country:US
Practice Address - Phone:734-408-1149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511101931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical