Healthcare Provider Details

I. General information

NPI: 1821120445
Provider Name (Legal Business Name): BLACK FAMILY DEVELOPMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2995 E GRAND BLVD
DETROIT MI
48202-3133
US

IV. Provider business mailing address

2995 E GRAND BLVD
DETROIT MI
48202-3133
US

V. Phone/Fax

Practice location:
  • Phone: 313-758-0150
  • Fax: 313-758-0255
Mailing address:
  • Phone: 313-758-0150
  • Fax: 313-758-0255

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 Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KENYATTA ANTOINETTE STEPHENS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 248-396-5419