Healthcare Provider Details

I. General information

NPI: 1124325964
Provider Name (Legal Business Name): P O W E R PEOPLE ORGANIZED WORKING EVOLVING REACHING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2011
Last Update Date: 12/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W MICHIGAN AVE
YPSILANTI MI
48197-5450
US

IV. Provider business mailing address

301 W MICHIGAN AVE
YPSILANTI MI
48197-5450
US

V. Phone/Fax

Practice location:
  • Phone: 734-961-1990
  • Fax: 734-961-1996
Mailing address:
  • Phone: 734-961-1990
  • Fax: 734-961-1996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number1447450226
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number6801035881
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1184818700
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1447450226
License Number StateMI

VIII. Authorized Official

Name: DR. CAROL V BURRELL-JACKSON
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW, LMSW
Phone: 734-961-1990