Healthcare Provider Details

I. General information

NPI: 1528517588
Provider Name (Legal Business Name): UNIQUE PRISON CONSULTANTS & COACHING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2016
Last Update Date: 09/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11138 FINDLAY ST
DETROIT MI
48205-4714
US

IV. Provider business mailing address

11138 FINDLAY STREET
DETROIT MI
48205
US

V. Phone/Fax

Practice location:
  • Phone: 313-433-3621
  • Fax: 313-922-4689
Mailing address:
  • Phone: 313-433-3621
  • Fax: 313-922-4689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: METECIA SMITH
Title or Position: CEO
Credential:
Phone: 313-433-3621