Healthcare Provider Details

I. General information

NPI: 1427953769
Provider Name (Legal Business Name): B & L SURVIVORS OF RAPE NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29788 GEORGETOWN DR
CHESTERFIELD MI
48051-2123
US

IV. Provider business mailing address

29788 GEORGETOWN DR
CHESTERFIELD MI
48051-2123
US

V. Phone/Fax

Practice location:
  • Phone: 734-444-9656
  • Fax:
Mailing address:
  • Phone: 734-444-9656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number StateNULL

VIII. Authorized Official

Name: BRANDY IRENE JACOBS
Title or Position: CEO AND FOUNDER
Credential:
Phone: 734-444-9656