| NPI | 1780944967 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MEAD GOEDERT Clinical Therapist 313-850-0469 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MI 6801089319) |
| Enumeration Date | 2012-05-22 |
| Last Update Date | 2012-05-22 |