Healthcare Provider Details

I. General information

NPI: 1134502354
Provider Name (Legal Business Name): MINDS MOVING IN NEW DIRECTIONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 08/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 MASSACHUSETTS ST
HIGHLAND PARK MI
48203
US

IV. Provider business mailing address

62 MASSACHUSETTS ST
HIGHLAND PARK MI
48203-3537
US

V. Phone/Fax

Practice location:
  • Phone: 313-883-3300
  • Fax: 313-731-0156
Mailing address:
  • Phone: 313-883-3300
  • Fax: 313-731-0156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: VICKY AVERY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 313-883-3300