Healthcare Provider Details

I. General information

NPI: 1386837490
Provider Name (Legal Business Name): CENTRO MULTICULTURAL LA FAMILIA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 W HURON ST SUITE 500
PONTIAC MI
48342-2120
US

IV. Provider business mailing address

35 W HURON ST SUITE 500
PONTIAC MI
48342-2120
US

V. Phone/Fax

Practice location:
  • Phone: 248-858-7800
  • Fax: 248-874-4830
Mailing address:
  • Phone: 248-858-7800
  • Fax: 248-874-4830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateMI

VIII. Authorized Official

Name: DR. SONIA ACOSTA
Title or Position: PRESIDENT/CEO
Credential: PHD
Phone: 248-858-7800