Healthcare Provider Details

I. General information

NPI: 1427301613
Provider Name (Legal Business Name): KIDS TALK CHILDREN'S ADVOCACY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2012
Last Update Date: 10/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 E FERRY ST
DETROIT MI
48202-3802
US

IV. Provider business mailing address

40 E FERRY ST
DETROIT MI
48202-3802
US

V. Phone/Fax

Practice location:
  • Phone: 313-833-2970
  • Fax: 313-638-2470
Mailing address:
  • Phone: 313-833-2970
  • Fax: 313-638-2470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. KARI D WALKER
Title or Position: PRESIDENT & CHIEF EXECUTIVE OFFICER
Credential: LMSW
Phone: 734-785-7700