Healthcare Provider Details

I. General information

NPI: 1649602350
Provider Name (Legal Business Name): FAMILY SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 08/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 PARSONS ST
DETROIT MI
48201-2002
US

IV. Provider business mailing address

1235 LAWNDALE ST
DETROIT MI
48209-1727
US

V. Phone/Fax

Practice location:
  • Phone: 313-831-1000
  • Fax:
Mailing address:
  • Phone: 313-841-6254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateMI
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateMI

VIII. Authorized Official

Name: DEBORAH SNYDER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 248-990-4337