Healthcare Provider Details

I. General information

NPI: 1114152147
Provider Name (Legal Business Name): STRIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 09/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 S 15TH ST
SAGINAW MI
48601-2008
US

IV. Provider business mailing address

PO BOX 14672
SAGINAW MI
48601-0672
US

V. Phone/Fax

Practice location:
  • Phone: 989-493-3077
  • Fax:
Mailing address:
  • Phone: 989-493-3077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number730213
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number730213
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number730213
License Number StateMI

VIII. Authorized Official

Name: MS. INEZ WILLIAMS
Title or Position: CEO
Credential:
Phone: 989-493-3077