Healthcare Provider Details

I. General information

NPI: 1114846649
Provider Name (Legal Business Name): A PATH TO PEACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 ANTIETAM AVE
DETROIT MI
48207-2832
US

IV. Provider business mailing address

1010 ANTIETAM AVE
DETROIT MI
48207-2832
US

V. Phone/Fax

Practice location:
  • Phone: 313-671-3188
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: MELBA LYNETTE CLARK
Title or Position: OWNER
Credential:
Phone: 231-343-0630