Active NPI
Blandina Margaret Rose-Willis, MED, PHD
- Counselor
- Detroit, MI
National Provider Identifier
1609532787
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 6401003078
- Practice address
- 1239 Bagley St
Detroit, MI 48226-1002 - Phone
- (313) 550-4130
- NPI assigned
- Nov 12, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 6401003078 | MI | Primary |
Addresses
Primary practice location
1239 Bagley St
Detroit, MI 48226-1002
Mailing address
1239 Bagley St
Detroit, MI 48226-1002
Phone (313) 550-4130
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Education, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6401003078 | MI | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1636675200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636675200000",
"number": "1609532787",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1239 BAGLEY ST",
"city": "DETROIT",
"state": "MI",
"postal_code": "482261002",
"telephone_number": "313-550-4130"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1239 BAGLEY ST",
"city": "DETROIT",
"state": "MI",
"postal_code": "482261002",
"telephone_number": "313-550-4130"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSE-WILLIS",
"first_name": "BLANDINA",
"middle_name": "MARGARET",
"credential": "MED, PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-11-12",
"last_updated": "2021-11-12",
"certification_date": "2021-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "MI",
"license": "6401003078",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.