Healthcare Provider Details

I. General information

NPI: 1972542835
Provider Name (Legal Business Name): ATTITUDE RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32841 AUGUSTA CT
ROMULUS MI
48174-6300
US

IV. Provider business mailing address

32841 AUGUSTA CT
ROMULUS MI
48174-6300
US

V. Phone/Fax

Practice location:
  • Phone: 313-516-5554
  • Fax:
Mailing address:
  • Phone: 313-516-5554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number720509
License Number StateMI

VIII. Authorized Official

Name: MR. JONATHAN HOMER HARMON
Title or Position: BOSS
Credential: BS, RSW
Phone: 313-516-5554