| NPI | 1972478485 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA CLEVELAND Program Director 313-768-9696 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 261QM2500X Clinic/Center, Medical Specialty | |
| Enumeration Date | 2025-10-06 |
| Last Update Date | 2025-10-06 |