Healthcare Provider Details

I. General information

NPI: 1922782937
Provider Name (Legal Business Name): SOCIAL JUSTICE LR CORP MANAGEMENT HOLDINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 TOWN CENTER DR
DEARBORN MI
48126-2718
US

IV. Provider business mailing address

3424 LUDWIG ST
LITTLE ROCK AR
72204-4470
US

V. Phone/Fax

Practice location:
  • Phone: 501-604-3330
  • Fax:
Mailing address:
  • Phone: 501-412-5520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. SEAN DAVIDSON
Title or Position: FOUNDER
Credential:
Phone: 501-604-3330