| NPI | 1134781719 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANAQUIL POWERS Administrator 248-632-1344 |
| Organization Subpart ? | No |
| Primary Taxonomy | 405300000X Prevention Professional |
| Additional Taxonomies | 101Y00000X Counselor |
| 1041C0700X Social Worker, Clinical | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2019-07-03 |
| Last Update Date | 2019-07-03 |