| NPI | 1356123285 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KISHVA DANIEL Administrator 313-850-9837 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2023-10-16 |
| Last Update Date | 2023-10-16 |