| NPI | 1275178402 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATASHA MARIE SHANNON CEO 734-635-3499 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2019-11-12 |
| Last Update Date | 2020-03-06 |