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General NPI Number Information
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NPI Number | 1609245216
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Entity Type | Organization
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Legal Business Name | ASCENSION SOUTHEAST MICHIGAN COMMUNITY HEALTH
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Dates
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Enumeration Date | 09/24/2015
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Last Update Date | 05/31/2019
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Provider Practice Location Address
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Address Line | 11600 E 7 MILE RD
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City | DETROIT
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State | MI
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Zip | 48205-2112
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Country | US
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Telephone | 313-373-5974
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Fax | 313-372-6579
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Provider Business Mailing Address
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Address Line | 11600 E 7 MILE RD
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City | DETROIT
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State | MI
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Zip | 48205-2112
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Country | US
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Telephone | 313-373-5974
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Fax | 313-372-6579
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Authorized Official
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Title or Position | BEHAVIORAL HEALLTH COUNSELOR
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Name | LONNIE FREDERICK HARVEY III
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Credential | MA, LLPC
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Telephone | 313-372-5974
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 6401013184
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License Number State | MI
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