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General NPI Number Information
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NPI Number | 1033553128
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Entity Type | Organization
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Legal Business Name | SOUTH CENTRAL MICHIGAN SUBSTANCE ABUSE COMMISSION MINORITY PROGRAM SER
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Dates
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Enumeration Date | 04/19/2013
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 600 E MICHIGAN AVE
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City | ALBION
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State | MI
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Zip | 49224-1849
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Country | US
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Telephone | 517-629-2113
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Fax | 517-905-5963
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Provider Business Mailing Address
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Address Line | 600 E MICHIGAN AVE
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City | ALBION
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State | MI
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Zip | 49224-1849
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Country | US
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Telephone | 517-629-2113
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Fax | 517-905-5963
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. HARRY J. BONNER SR.
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Credential | MCBAP CERTIFIED
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Telephone | 517-629-2113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State | MI
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