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General NPI Number Information
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NPI Number | 1184569659
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Entity Type | Organization
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Legal Business Name | REAL IMPACT BEHAVIORAL HEALTH CENTER
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Dates
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Enumeration Date | 04/21/2026
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Last Update Date | 04/21/2026
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Provider Practice Location Address
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Address Line | 29623 NORTHWESTERN HWY STE 6
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1076
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Country | US
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Telephone | 313-920-9046
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Fax | 313-731-1991
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Provider Business Mailing Address
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Address Line | 628 PINGREE ST
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City | DETROIT
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State | MI
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Zip | 48202-2024
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Country | US
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Telephone | 313-920-9046
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Fax | 313-731-1991
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Authorized Official
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Title or Position | CEO
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Name | MRS. DOROTHEA FOSTER
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Credential | LPC
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Telephone | 313-920-9046
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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