Healthcare Provider Details

I. General information

NPI: 1093783052
Provider Name (Legal Business Name): KEY DEVELOPMENT CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 GRAND RIVER ANX STE 600
BRIGHTON MI
48114-5312
US

IV. Provider business mailing address

2060 GRAND RIVER ANX STE 600
BRIGHTON MI
48114-5312
US

V. Phone/Fax

Practice location:
  • Phone: 810-220-8192
  • Fax:
Mailing address:
  • Phone: 810-220-8192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number470055
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number4700057
License Number StateMI

VIII. Authorized Official

Name: MS. ANNE M. KING-HUDSON
Title or Position: EXECUTIVE DIRECTOR
Credential: MA, CADC,CSS,CPS
Phone: 810-220-8192