Healthcare Provider Details

I. General information

NPI: 1285116244
Provider Name (Legal Business Name): PREVENTION CONCEPTS AND SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2018
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W SAINT CLAIR ST
ROMEO MI
48065-4654
US

IV. Provider business mailing address

104 W SAINT CLAIR ST
ROMEO MI
48065-4654
US

V. Phone/Fax

Practice location:
  • Phone: 248-977-6799
  • Fax:
Mailing address:
  • Phone: 248-977-6799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberSA0500496
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberSA0500496
License Number StateMI

VIII. Authorized Official

Name: DAVID A DUDEK
Title or Position: CEO
Credential:
Phone: 248-212-5980