Healthcare Provider Details

I. General information

NPI: 1104440320
Provider Name (Legal Business Name): HOW- SUBSTANCE ABUSE ABUSE PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8131 E OUTER DR
DETROIT MI
48213-1323
US

IV. Provider business mailing address

51762 EVA DR
MACOMB MI
48042-4234
US

V. Phone/Fax

Practice location:
  • Phone: 248-842-0428
  • Fax: 248-850-7424
Mailing address:
  • Phone: 248-842-0428
  • Fax: 248-850-7424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GREORY FRANKLIN
Title or Position: OWNER
Credential:
Phone: 248-842-0428