| NPI | 1710102249 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH DWAYNE PERRY Clinic Supervisor 313-887-6760 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 820522) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2020-08-22 |