| NPI | 1972016004 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA JO-RADEMACHER LEWIS Owner 734-770-0845 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2017-11-11 |
| Last Update Date | 2023-08-07 |