Provider Demographics
NPI:1861980609
Name:OAKLAND HEALTH ASSOCIATE OF WATERFORD CLARKSTON
Entity type:Organization
Organization Name:OAKLAND HEALTH ASSOCIATE OF WATERFORD CLARKSTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SEBI
Authorized Official - Middle Name:R
Authorized Official - Last Name:FISHTA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC/PHD (CAND)
Authorized Official - Phone:586-770-9409
Mailing Address - Street 1:4567 W WALTON BLVD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-4078
Mailing Address - Country:US
Mailing Address - Phone:586-770-9409
Mailing Address - Fax:
Practice Address - Street 1:4576 W WALTON BLVD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-4905
Practice Address - Country:US
Practice Address - Phone:586-770-9409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-26
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty