Healthcare Provider Details

I. General information

NPI: 1790320331
Provider Name (Legal Business Name): FAITH HOPE & LOVE OUTREACH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2019
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18284 JAMES COUZENS FWY.
DETROIT MI
48235-2503
US

IV. Provider business mailing address

18284 JAMES COUZENS FWY.
DETROIT MI
48235-2503
US

V. Phone/Fax

Practice location:
  • Phone: 313-646-6864
  • Fax:
Mailing address:
  • Phone: 313-646-6864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. DJUANA L COATS
Title or Position: EXECUTIVE DIRECTOR
Credential: MCC
Phone: 313-646-6864