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General NPI Number Information
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NPI Number | 1356522312
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Entity Type | Organization
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Legal Business Name | SISTAH GIRLS INC.
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Dates
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Enumeration Date | 11/19/2007
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Last Update Date | 11/19/2007
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Provider Practice Location Address
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Address Line | 15863 CHATHAM ST
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City | DETROIT
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State | MI
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Zip | 48223-1003
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Country | US
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Telephone | 313-629-9247
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Fax |
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Provider Business Mailing Address
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Address Line | 15863 CHATHAM ST
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City | DETROIT
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State | MI
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Zip | 48223-1003
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Country | US
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Telephone | 313-629-9247
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. VALERIE DAVIS
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Credential |
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Telephone | 313-629-9247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | MI
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