| NPI | 1184969719 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE G RUSSELL Social Worker 248-996-5383 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MI 6801066657) |
| Enumeration Date | 2012-12-07 |
| Last Update Date | 2012-12-07 |