=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144627027
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NURTURING OUR FUTURE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2014
-----------------------------------------------------
Last Update Date | 02/13/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25925 TELEGRAPH RD STE 103
-----------------------------------------------------
City | SOUTHFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48033-2527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-405-8064
-----------------------------------------------------
Fax | 313-429-7649
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 753
-----------------------------------------------------
City | EASTPOINTE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48021-0753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-405-8064
-----------------------------------------------------
Fax | 313-429-7649
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/SOCIAL WORKER
-----------------------------------------------------
Name | MS. TACARA L WOODS
-----------------------------------------------------
Credential | LMSW
-----------------------------------------------------
Telephone | 313-308-5510
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number | 6801097458
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------