Healthcare Provider Details

I. General information

NPI: 1902284193
Provider Name (Legal Business Name): THERAPEUTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2015
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 E WEST MAPLE RD STE 200
WALLED LAKE MI
48390-3571
US

IV. Provider business mailing address

1010 E WEST MAPLE RD STE 200
WALLED LAKE MI
48390-3571
US

V. Phone/Fax

Practice location:
  • Phone: 248-970-1602
  • Fax: 734-384-3222
Mailing address:
  • Phone: 248-970-1602
  • Fax: 734-384-3222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License NumberSA0631371
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEIDRE VIAN GOLDSMITH
Title or Position: PROGRAM DIRECTOR
Credential: CRNA
Phone: 248-525-6832