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General NPI Number Information
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NPI Number | 1083981724
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Entity Type | Organization
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Legal Business Name | STEPHEN BURDEN DBA MARY LEE COMMUNITY HEALTH & TRAINING CENTER
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Dates
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Enumeration Date | 11/23/2011
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Last Update Date | 02/07/2023
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Provider Practice Location Address
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Address Line | 25822 W 6 MILE RD
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City | REDFORD
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State | MI
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Zip | 48240-2211
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Country | US
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Telephone | 313-286-3031
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Fax | 313-286-3135
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Provider Business Mailing Address
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Address Line | 24633 PEMBROOKE DR
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City | SOUTHFIELD
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State | MI
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Zip | 48033-3159
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Country | US
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Telephone | 248-719-4335
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MRS. TONYA MARETTA MOSS
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Credential | DNP, NP-C
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Telephone | 313-286-3031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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