Healthcare Provider Details

I. General information

NPI: 1932574522
Provider Name (Legal Business Name): WOMEN AND GIRLS EMPOWERMENT CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2015
Last Update Date: 12/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 N MAIN ST
PLYMOUTH MI
48170-1236
US

IV. Provider business mailing address

164 N. MAIN ST.
PLYMOUTH MI
48170
US

V. Phone/Fax

Practice location:
  • Phone: 734-656-8225
  • Fax:
Mailing address:
  • Phone: 734-656-8225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELISSA PERSECHINI
Title or Position: OWNER
Credential: LMSW, CAADC, CTS
Phone: 734-656-8225