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General NPI Number Information
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NPI Number | 1245533124
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Entity Type | Organization
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Legal Business Name | ALLIANCENET
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Dates
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Enumeration Date | 12/14/2010
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Last Update Date | 09/21/2015
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Provider Practice Location Address
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Address Line | 6330 BLOOMFIELD GLENS RD
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-2513
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Country | US
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Telephone | 248-217-1677
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Fax | 248-626-3759
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Provider Business Mailing Address
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Address Line | 6330 BLOOMFIELD GLENS RD
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-2513
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Country | US
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Telephone | 248-217-1677
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Fax | 248-626-3759
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. KENNETH L WOLF
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Credential | PH.D.
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Telephone | 248-217-1677
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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 | 6301002014
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License Number State | MI
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