Healthcare Provider Details

I. General information

NPI: 1245407873
Provider Name (Legal Business Name): SPECTRUM CHILD AND FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7430 2ND AVE
DETROIT MI
48202-2739
US

IV. Provider business mailing address

28303 JOY RD
WESTLAND MI
48185-5524
US

V. Phone/Fax

Practice location:
  • Phone: 313-456-6036
  • Fax:
Mailing address:
  • Phone: 734-458-8736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number821956
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: SHIRLEY EDWARDS
Title or Position: EXECUTIVE DIRECTOR
Credential: LMSW
Phone: 734-458-8736