Healthcare Provider Details

I. General information

NPI: 1700904828
Provider Name (Legal Business Name): DETROIT EAST COMMUNITY MENTAL HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 08/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3646 MOUNT ELLIOTT ST
DETROIT MI
48207-2311
US

IV. Provider business mailing address

3646 MOUNT ELLIOTT ST
DETROIT MI
48207-2311
US

V. Phone/Fax

Practice location:
  • Phone: 313-392-0387
  • Fax:
Mailing address:
  • Phone: 313-392-0387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number6801001987
License Number StateMI

VIII. Authorized Official

Name: MRS. DORIS EVELYN STERRETT
Title or Position: PROGRAM SUPERVISOR
Credential: LMSW, CAC II
Phone: 313-921-4700