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General NPI Number Information
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NPI Number | 1245722032
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Entity Type | Organization
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Legal Business Name | WATKINS AFC FAMILY HOME L.L.C.
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Dates
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Enumeration Date | 06/06/2018
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Last Update Date | 06/06/2018
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Provider Practice Location Address
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Address Line | 49783 PARKSIDE DR
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City | NORTHVILLE
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State | MI
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Zip | 48168-6821
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Country | US
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Telephone | 248-773-1682
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Fax | 248-308-3283
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Provider Business Mailing Address
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Address Line | 49783 PARKSIDE DR
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City | NORTHVILLE
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State | MI
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Zip | 48168-6821
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Country | US
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Telephone | 248-773-1682
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Fax | 248-308-3283
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Authorized Official
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Title or Position | MEMBER/EXECUTIVE DIRECTOR
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Name | CORLISS MICHELE WATKINS
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Credential |
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Telephone | 248-773-1682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | AF
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License Number State | MI
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