Healthcare Provider Details

I. General information

NPI: 1689098121
Provider Name (Legal Business Name): ENNIS CENTER FOR CHILDREN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2014
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20100 GREENFIELD RD
DETROIT MI
48235
US

IV. Provider business mailing address

129 E 3RD ST
FLINT MI
48502-1728
US

V. Phone/Fax

Practice location:
  • Phone: 313-342-2699
  • Fax: 313-342-2180
Mailing address:
  • Phone: 810-233-4031
  • Fax: 810-237-4141

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: ROBERT ENNIS
Title or Position: PRESIDENT
Credential: LMSW
Phone: 810-233-4031