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NPI Code Detail

MEDICARE: GOODWILL INDUSTRIES OF GREATER DETROIT

MEDICARE: GOODWILL INDUSTRIES OF GREATER DETROIT
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
1101YM0800XMental Health Counselor
2171M00000XCase Manager/Care Coordinator

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1548358245
Entity Type Code : Organization
Provider Name (Legal Business Name) : GOODWILL INDUSTRIES OF GREATER DETROIT
Provider Business Mailing Address
First Line : 3111 GRAND RIVER AVE
Second Line :
City : DETROIT
State : MI
Zip : 48208-2962
Country : US
Telephone Number : 313-964-3900
Fax Number : 313-964-3909
Provider Business Practice Location Address
First Line : 3111 GRAND RIVER AVE
Second Line :
City : DETROIT
State : MI
Zip : 48208-2962
Country : US
Telephone Number : 313-964-3900
Fax Number : 313-964-3909
Authorized Official
Title or Position : PRESIDENT AND CEO
Name : MS. LORNA G UTLEY
Credential :
Telephone Number : 313-557-8787
Provider Enumeration Date : 10/10/2006
Last Update Date : 03/18/2011

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1942962410 — MICHELLE K YORK LMSW
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1215696927 — ANTHOLYN FLOYED-JACKSON
Practice Location Address:
3111 GRAND RIVER AVE
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48208-2962
Practice Phone: 313-557-8620
Practice Fax:
1073272225 — LAKESHA WASHINGTON
Practice Location Address:
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DETROIT, MI
48208-2962
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Practice Fax:
1104555275 — MYRIAH GRAHAM
Practice Location Address:
3111 GRAND RIVER AVE
DETROIT, MI
48208-2962
Practice Phone: 313-557-8719
Practice Fax: 313-456-9601

Directions to “GOODWILL INDUSTRIES OF GREATER DETROIT ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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