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General NPI Number Information
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NPI Number | 1386083541
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Entity Type | Organization
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Legal Business Name | AARIC CARE OUTPATIENT PROGRAM
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Dates
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Enumeration Date | 06/20/2013
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Last Update Date | 06/20/2013
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Provider Practice Location Address
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Address Line | 17830 E WARREN AVE
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City | DETROIT
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State | MI
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Zip | 48224-1332
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Country | US
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Telephone | 313-784-5348
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Fax |
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Provider Business Mailing Address
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Address Line | 17830 E WARREN AVE
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City | DETROIT
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State | MI
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Zip | 48224-1332
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Country | US
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Telephone | 313-784-5348
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MS. ZIPPORAH K BOLAR
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Credential | LLPC
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Telephone | 313-784-5348
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 823200
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License Number State | MI
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