Healthcare Provider Details

I. General information

NPI: 1962988576
Provider Name (Legal Business Name): PAMS PLACE COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2441 W GRAND BLVD STE 202
DETROIT MI
48208-1229
US

IV. Provider business mailing address

2441 W GRAND BLVD STE 202
DETROIT MI
48208-1229
US

V. Phone/Fax

Practice location:
  • Phone: 313-894-8088
  • Fax: 313-894-8888
Mailing address:
  • Phone: 313-894-8088
  • Fax: 313-894-8888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401007590
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES T EDGAR JR.
Title or Position: EXECUTIVE DIRECTOR
Credential: LLPC
Phone: 313-894-8088