Healthcare Provider Details

I. General information

NPI: 1427417476
Provider Name (Legal Business Name): TRUE TESTING ALCOHOL & DRUG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2016
Last Update Date: 02/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13310 W MCNICHOLS RD
DETROIT MI
48235-4121
US

IV. Provider business mailing address

13310 W MCNICHOLS RD
DETROIT MI
48235-4121
US

V. Phone/Fax

Practice location:
  • Phone: 313-279-0460
  • Fax: 313-279-0463
Mailing address:
  • Phone: 313-279-0460
  • Fax: 313-279-0463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401011475
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6802079555
License Number StateMI

VIII. Authorized Official

Name: MR. KENNETH CALHOUN
Title or Position: CLINICAL DIRECTOR
Credential: MA/LBSW/LLPC
Phone: 313-279-0460