Healthcare Provider Details

I. General information

NPI: 1093987240
Provider Name (Legal Business Name): INNOVATIVE THERAPEUTIC SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 W. CONGRESS ST. SUITE 306
DETROIT MI
48226-3272
US

IV. Provider business mailing address

PO BOX 44805
DETROIT MI
48244-0805
US

V. Phone/Fax

Practice location:
  • Phone: 313-964-2648
  • Fax: 866-468-9584
Mailing address:
  • Phone: 313-964-2648
  • Fax: 866-468-9584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number6801089872
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number6801089872
License Number StateMI

VIII. Authorized Official

Name: MS. TASHA LYNTRICE WILLIAMS
Title or Position: EXECUTIVE DIRECTOR
Credential: LMSW, CAADC, SAP
Phone: 313-658-3346