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General NPI Number Information
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NPI Number | 1427336411
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Entity Type | Organization
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Legal Business Name | NORTHEAST GUIDANCE CENTER
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Dates
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Enumeration Date | 07/26/2011
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Last Update Date | 07/26/2011
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Provider Practice Location Address
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Address Line | 12800 E WARREN AVE
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City | DETROIT
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State | MI
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Zip | 48215-2061
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Country | US
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Telephone | 313-824-8000
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Fax | 313-824-5589
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Provider Business Mailing Address
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Address Line | 2900 CONNER AVENUE BLDG A
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City | DETROIT
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State | MI
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Zip | 48215
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Country | US
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Telephone | 313-308-1400
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Fax | 313-308-1600
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | SUE NEDERLANDER
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Credential |
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Telephone | 313-824-5642
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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