| NPI | 1033759659 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SEVERIA ADOLPHUS Clinical Director 313-915-9138 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 364SP0808X Clinical Nurse Specialist, Psych/Mental Health | |
| Enumeration Date | 2020-01-11 |
| Last Update Date | 2021-10-19 |