Healthcare Provider Details

I. General information

NPI: 1144627027
Provider Name (Legal Business Name): NURTURING OUR FUTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2014
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25925 TELEGRAPH RD STE 103
SOUTHFIELD MI
48033-2527
US

IV. Provider business mailing address

PO BOX 753
EASTPOINTE MI
48021-0753
US

V. Phone/Fax

Practice location:
  • Phone: 313-405-8064
  • Fax: 313-429-7649
Mailing address:
  • Phone: 313-405-8064
  • Fax: 313-429-7649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number6801097458
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. TACARA L WOODS
Title or Position: OWNER/SOCIAL WORKER
Credential: LMSW
Phone: 313-308-5510