Healthcare Provider Details

I. General information

NPI: 1922415488
Provider Name (Legal Business Name): ADULT WELL BEING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2014
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15200 E JEFFERSON AVE STE 106
GROSSE POINTE MI
48230-2055
US

IV. Provider business mailing address

1423 FIELD ST
DETROIT MI
48214-2321
US

V. Phone/Fax

Practice location:
  • Phone: 313-879-5029
  • Fax:
Mailing address:
  • Phone: 313-347-2070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number6801094722
License Number StateMI

VIII. Authorized Official

Name: MS. KATHERINE DILLON
Title or Position: SOCIAL SERVICE WORKER
Credential: LLMSW
Phone: 313-879-5029