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General NPI Number Information
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NPI Number | 1548358245
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Entity Type | Organization
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Legal Business Name | GOODWILL INDUSTRIES OF GREATER DETROIT
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 03/18/2011
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Provider Practice Location Address
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Address Line | 3111 GRAND RIVER AVE
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City | DETROIT
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State | MI
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Zip | 48208-2962
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Country | US
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Telephone | 313-964-3900
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Fax | 313-964-3909
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Provider Business Mailing Address
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Address Line | 3111 GRAND RIVER AVE
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City | DETROIT
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State | MI
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Zip | 48208-2962
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Country | US
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Telephone | 313-964-3900
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Fax | 313-964-3909
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | MS. LORNA G UTLEY
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Credential |
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Telephone | 313-557-8787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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