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General NPI Number Information
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NPI Number | 1174803571
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Entity Type | Organization
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Legal Business Name | DETROIT FAMILY CENTER, LLC
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Dates
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Enumeration Date | 08/17/2011
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Last Update Date | 08/17/2011
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Provider Practice Location Address
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Address Line | 24564 RAVEN AVE
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City | EASTPOINTE
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State | MI
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Zip | 48021-1408
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Country | US
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Telephone | 313-525-0142
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Fax |
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Provider Business Mailing Address
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Address Line | 24564 RAVEN AVE
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City | EASTPOINTE
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State | MI
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Zip | 48021-1408
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Country | US
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Telephone | 313-525-0142
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. MARCELLA MAREA PAYNE CHARLEY
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Credential | MA, LLPC, CAADC
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Telephone | 313-208-9947
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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 | 6401009381
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License Number State | MI
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