Healthcare Provider Details

I. General information

NPI: 1427336411
Provider Name (Legal Business Name): NORTHEAST GUIDANCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2011
Last Update Date: 07/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12800 E WARREN AVE
DETROIT MI
48215-2061
US

IV. Provider business mailing address

2900 CONNER AVENUE BLDG A
DETROIT MI
48215
US

V. Phone/Fax

Practice location:
  • Phone: 313-824-8000
  • Fax: 313-824-5589
Mailing address:
  • Phone: 313-308-1400
  • Fax: 313-308-1600

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 Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: SUE NEDERLANDER
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 313-824-5642