Active NPI
Evan Theodore Fulford, LMSW
- Clinical Social Worker
- Detroit, MI
National Provider Identifier
1669091286
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 6801106033
- Practice address
- 19928 Lichfield Rd
Detroit, MI 48221-1363 - Phone
- (313) 804-8128
- NPI assigned
- Apr 14, 2020
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 6801106033 | MI | Primary |
Addresses
Primary practice location
19928 Lichfield Rd
Detroit, MI 48221-1363
Mailing address
19928 Lichfield Rd
Detroit, MI 48221-1363
Phone (313) 804-8128
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6801106033 | MI | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1586822400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1586822400000",
"number": "1669091286",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19928 LICHFIELD RD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482211363",
"telephone_number": "313-804-8128"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19928 LICHFIELD RD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482211363",
"telephone_number": "313-804-8128"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULFORD",
"first_name": "EVAN",
"middle_name": "THEODORE",
"credential": "LMSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-04-14",
"last_updated": "2020-04-14",
"certification_date": "2020-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MI",
"license": "6801106033",
"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 Apr 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.