MEDICARE: AARIC CARE OUTPATIENT PROGRAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	823200	MI

General Provider Information

NPI Number	:	1386083541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AARIC CARE OUTPATIENT PROGRAM

Provider Business Mailing Address
First Line	:	17830 E WARREN AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48224-1332
Country	:	US
Telephone Number	:	313-784-5348
Fax Number	:

Provider Business Practice Location Address
First Line	:	17830 E WARREN AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48224-1332
Country	:	US
Telephone Number	:	313-784-5348
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MS. ZIPPORAH K BOLAR
Credential	:	LLPC
Telephone Number	:	313-784-5348

Provider Enumeration Date	:	06/20/2013
Last Update Date	:	06/20/2013

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