Healthcare Provider Details

I. General information

NPI: 1891245775
Provider Name (Legal Business Name): PLATINUM PSYCHOLOGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2016
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 KERCHEVAL AVE STE 371
GROSSE POINTE FARMS MI
48236-3698
US

IV. Provider business mailing address

21 KERCHEVAL AVE STE 371
GROSSE POINTE FARMS MI
48236-3698
US

V. Phone/Fax

Practice location:
  • Phone: 313-806-7552
  • Fax:
Mailing address:
  • Phone: 313-806-7552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301015998
License Number StateMI

VIII. Authorized Official

Name: DR. DEMETRIUS EDWIN FORD
Title or Position: PSYCHOLOGIST
Credential: PSY. D. LLP
Phone: 313-806-7552