Healthcare Provider Details

I. General information

NPI: 1578850251
Provider Name (Legal Business Name): DETROIT RECOVERY PROJECT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 09/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 EAST MC NICHOLS
DETROIT MI
48203
US

IV. Provider business mailing address

1121 EAST MC NICHOLS
DETROIT MI
48203
US

V. Phone/Fax

Practice location:
  • Phone: 313-365-3113
  • Fax: 313-365-3098
Mailing address:
  • Phone: 313-365-3113
  • Fax: 313-365-3098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. VIRDELL FAUSTINA THOMAS
Title or Position: CLINICAL DIRECTOR
Credential: MSW, LMSW
Phone: 313-365-3113