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General NPI Number Information
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NPI Number | 1124325964
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Entity Type | Organization
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Legal Business Name | P O W E R PEOPLE ORGANIZED WORKING EVOLVING REACHING
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Dates
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Enumeration Date | 02/14/2011
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Last Update Date | 12/30/2015
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Provider Practice Location Address
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Address Line | 301 W MICHIGAN AVE
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City | YPSILANTI
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State | MI
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Zip | 48197-5450
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Country | US
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Telephone | 734-961-1990
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Fax | 734-961-1996
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Provider Business Mailing Address
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Address Line | 301 W MICHIGAN AVE
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City | YPSILANTI
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State | MI
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Zip | 48197-5450
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Country | US
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Telephone | 734-961-1990
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Fax | 734-961-1996
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. CAROL V BURRELL-JACKSON
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Credential | MSW, LMSW
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Telephone | 734-961-1990
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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 | 1184818700
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1447450226
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 1447450226
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6801035881
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License Number State |
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