Healthcare Provider Details

I. General information

NPI: 1235601170
Provider Name (Legal Business Name): THE DETROIT ASSOCIATION OF BLACK ORGANIZATION DABO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12048 GRAND RIVER AVE
DETROIT MI
48204-1836
US

IV. Provider business mailing address

12048 GRAND RIVER AVE
DETROIT MI
48204-1836
US

V. Phone/Fax

Practice location:
  • Phone: 313-491-0003
  • Fax: 313-491-0252
Mailing address:
  • Phone: 313-491-0003
  • Fax: 313-491-0252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. HORACE LINDSEY SHEFFIELD III
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 313-491-0003