Healthcare Provider Details

I. General information

NPI: 1114144847
Provider Name (Legal Business Name): COUNTY OF WAYNE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 01/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 E FOREST AVE BUILDING C
DETROIT MI
48207-1024
US

IV. Provider business mailing address

1025 E FOREST AVE BUILDING C
DETROIT MI
48207-1024
US

V. Phone/Fax

Practice location:
  • Phone: 313-833-2800
  • Fax: 313-833-2841
Mailing address:
  • Phone: 313-833-2800
  • Fax: 313-833-2841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. MICHELLE A ESTERBROOK
Title or Position: DIRECTOR OF CLINIC OPERATIONS
Credential: MSW, LMSW
Phone: 313-833-2830