| NPI | 1073379525 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMRA SAMUELS Behavioral Clinician 313-433-3267 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 251B00000X Case Management |
| 251K00000X Public Health or Welfare | |
| 251S00000X | |
| 251V00000X Voluntary or Charitable | |
| 252Y00000X Early Intervention Provider Agency | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 322D00000X Residential Treatment Facility, Emotionally Disturbed Children | |
| Enumeration Date | 2024-02-22 |
| Last Update Date | 2024-02-22 |