| NPI | 1760346936 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE POWELL Credentialing 248-461-2910 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2025-12-12 |
| Last Update Date | 2025-12-12 |