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General NPI Number Information
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NPI Number | 1104930957
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Entity Type | Individual
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Provider Name | LESLIE MARIE BRADEN MS, LLP
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Gender | Female
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4646 JOHN R ST
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City | DETROIT
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State | MI
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Zip | 48201-1916
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Country | US
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Telephone | 313-576-4931
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Fax |
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Provider Business Mailing Address
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Address Line | 23243 15 MILE RD APT. # 113
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48035-3196
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Country | US
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Telephone | 586-791-7077
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 6301006716
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License Number State | MI
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