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General NPI Number Information
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NPI Number | 1225485329
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Entity Type | Organization
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Legal Business Name | CREATING OPPORTUNITIES FOR INFANTS CHILDREN AND EXPECTANT MOTHERS
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Dates
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Enumeration Date | 05/18/2016
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Last Update Date | 05/18/2016
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Provider Practice Location Address
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Address Line | 12150 SCHAEFER HWY APT 108
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City | DETROIT
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State | MI
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Zip | 48227-3491
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Country | US
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Telephone | 313-854-7086
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Fax |
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Provider Business Mailing Address
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Address Line | 3701 15TH ST 221
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City | DETROIT
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State | MI
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Zip | 48208-2586
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Country | US
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Telephone | 313-854-7086
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | MISS TAMIKO DU-SHEAN CONNER
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Credential | LLMSW
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Telephone | 313-854-7086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | 6801094586
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License Number State | MI
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