Healthcare Provider Details

I. General information

NPI: 1104259043
Provider Name (Legal Business Name): FAMILY SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2013
Last Update Date: 08/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 LONYO ST
DETROIT MI
48210-2189
US

IV. Provider business mailing address

120 PARSONS ST
DETROIT MI
48201-2002
US

V. Phone/Fax

Practice location:
  • Phone: 313-579-5989
  • Fax:
Mailing address:
  • Phone: 313-579-5989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateMI

VIII. Authorized Official

Name: DEBORAH M SNYDER
Title or Position: EXECUTIVE DIRECTOR
Credential: LLP
Phone: 313-579-5989