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General NPI Number Information
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NPI Number | 1063953834
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Entity Type | Organization
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Legal Business Name | DAUGHTER STATUS FOUNDATION
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Dates
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Enumeration Date | 03/13/2017
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Last Update Date | 03/13/2017
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Provider Practice Location Address
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Address Line | 24901 NORTHWESTERN HWY SUITE 600
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City | SOUTHFIELD
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State | MI
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Zip | 48075-2203
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Country | US
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Telephone | 810-287-8822
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Fax |
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Provider Business Mailing Address
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Address Line | 43237 CAPE DR
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City | STERLING HEIGHTS
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State | MI
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Zip | 48313-2334
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Country | US
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Telephone | 810-287-8822
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MISS JOY PATRICIA CREEL
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Credential | LPC
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Telephone | 810-287-8822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6401014431
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License Number State | MI
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