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General NPI Number Information
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NPI Number | 1417104498
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Entity Type | Organization
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Legal Business Name | INNERVISIONS OF MICHIGAN
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Dates
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Enumeration Date | 08/21/2008
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Last Update Date | 08/21/2008
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Provider Practice Location Address
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Address Line | 8426 PIERSON ST
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City | DETROIT
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State | MI
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Zip | 48228-2830
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Country | US
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Telephone | 313-399-1740
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Fax |
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Provider Business Mailing Address
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Address Line | 8426 PIERSON ST
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City | DETROIT
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State | MI
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Zip | 48228-2830
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Country | US
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Telephone | 313-399-1740
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. CAPRICE ELLENE QUINN
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Credential | LPC, CRC
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Telephone | 313-399-1740
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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 | 6401009466
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License Number State | MI
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