| NPI | 1205358512 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE LAFOREST Agent 313-633-4358 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: MI 6801093987) |
| Enumeration Date | 2017-07-10 |
| Last Update Date | 2023-06-29 |