=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205854916
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DETROIT EAST, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11457 SHOEMAKER ST
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48213-3418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-331-3435
-----------------------------------------------------
Fax | 313-921-4125
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11457 SHOEMAKER ST
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48213-3418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-331-3435
-----------------------------------------------------
Fax | 313-921-4125
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | MS. MARILYN SNOWDEN
-----------------------------------------------------
Credential | LMSW
-----------------------------------------------------
Telephone | 313-331-3435
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QR0405X
-----------------------------------------------------
Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------