Healthcare Provider Details

I. General information

NPI: 1841313764
Provider Name (Legal Business Name): ABBOTT ROAD CENTER FOR THE FAMILY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 ABBOTT RD
EAST LANSING MI
48823-3170
US

IV. Provider business mailing address

921 ABBOTT RD
EAST LANSING MI
48823-3170
US

V. Phone/Fax

Practice location:
  • Phone: 517-351-2590
  • Fax: 517-351-2733
Mailing address:
  • Phone: 517-351-2590
  • Fax: 517-351-2733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6801058299
License Number StateMI

VIII. Authorized Official

Name: MR. YUSUF NA ABDULLAH
Title or Position: MENTAL HEALTH COUNSELOR
Credential: MED,LSMW
Phone: 517-351-2590