Healthcare Provider Details

I. General information

NPI: 1720562697
Provider Name (Legal Business Name): CDAGAPE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1098 ANN ARBOR RD W
PLYMOUTH MI
48170-2129
US

IV. Provider business mailing address

1098 ANN ARBOR RD W
PLYMOUTH MI
48170-2129
US

V. Phone/Fax

Practice location:
  • Phone: 248-978-5862
  • Fax:
Mailing address:
  • Phone: 248-978-5862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID RONALD ADAMS JR.
Title or Position: MANAGING MEMBER/ CEO
Credential: LPC
Phone: 313-715-9577