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General NPI Number Information
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NPI Number | 1376840181
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Entity Type | Organization
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Legal Business Name | SELF HELP ADDICTION REHABILIATION
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Dates
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Enumeration Date | 02/15/2011
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Last Update Date | 02/15/2011
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Provider Practice Location Address
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Address Line | 4216 MCDOUGALL ST
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City | DETROIT
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State | MI
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Zip | 48207-1520
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Country | US
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Telephone | 313-923-6300
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Fax |
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Provider Business Mailing Address
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Address Line | 16633 HUBBELL ST
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City | DETROIT
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State | MI
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Zip | 48235-4524
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Country | US
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Telephone | 313-836-1633
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MS. JOYCE ELAINE SAVAGE
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Credential | M.S, L.L.P.C.
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Telephone | 313-923-6300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 6401012143
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License Number State | MI
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