| NPI | 1164721890 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA D. POWELL MEDLOCK Mental Health Clinician 248-475-6300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: MI 1041c0700x) |
| Enumeration Date | 2011-03-21 |
| Last Update Date | 2022-08-26 |