| NPI | 1225427917 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBER DAWN BURKHARDT-SIDEBOTTOM Clinical Social Worker 734-276-2765 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: MI 6801087977) |
| Additional Taxonomies | 261QM0850X Clinic/Center Adult Mental Health (Licence: MI 6801087977) |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health (Licence: MI 6801087977) | |
| Enumeration Date | 2015-01-18 |
| Last Update Date | 2015-01-18 |