| NPI | 1750405734 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GAYNELLA JACKSON Clinical Director 248-569-9846 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801059515) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2020-08-22 |