=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497872386
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DDP INVESTMENT INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1426 BOULEVARD
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-929-3422
-----------------------------------------------------
Fax | 313-387-4887
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1426 BOULEVARD
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-929-3422
-----------------------------------------------------
Fax | 313-387-4887
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. DAVID COLEMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 313-929-3422
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | L787236
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------