Healthcare Provider Details

I. General information

NPI: 1649091067
Provider Name (Legal Business Name): THE CENTER FOR URBAN YOUTH AND FAMILY DEVELOPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15827 INDIANA ST
DETROIT MI
48238-1105
US

IV. Provider business mailing address

35952 SCHOOLCRAFT RD
LIVONIA MI
48150-1217
US

V. Phone/Fax

Practice location:
  • Phone: 313-340-3101
  • Fax:
Mailing address:
  • Phone: 734-377-0087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State

VIII. Authorized Official

Name: MARSIALLE D ARBUCKLE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 313-340-3101