Healthcare Provider Details

I. General information

NPI: 1225597669
Provider Name (Legal Business Name): STOP THE VIOLENCE PREVENTION OUTREACH PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2019
Last Update Date: 03/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28820 SOUTHFIELD RD STE 124
LATHRUP VILLAGE MI
48076-2775
US

IV. Provider business mailing address

28820 SOUTHFIELD RD STE 124
LATHRUP VILLAGE MI
48076-2775
US

V. Phone/Fax

Practice location:
  • Phone: 313-221-3000
  • Fax: 844-500-0445
Mailing address:
  • Phone: 313-221-3000
  • Fax: 844-500-0445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. JOYCE JONES
Title or Position: CONFLICT RESOLUTION CONSULTANT/CEO
Credential: DOCTORATE DIVINITY
Phone: 313-221-3000