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General NPI Number Information
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NPI Number | 1609300490
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Entity Type | Organization
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Legal Business Name | TRANSFORMATION CENTER FOR VICTIMS OF ABUSE
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Dates
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Enumeration Date | 04/18/2017
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Last Update Date | 04/18/2017
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Provider Practice Location Address
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Address Line | 23411 JEFFERSON AVE 107
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-1949
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Country | US
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Telephone | 586-585-1789
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Fax | 586-585-1332
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Provider Business Mailing Address
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Address Line | 23411 JEFFERSON AVE 107
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-1949
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Country | US
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Telephone | 586-585-1789
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Fax | 586-585-1332
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Authorized Official
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Title or Position | FOUNDER/PRESIDENT/CEO
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Name | MS. DELLA MARIE HAMBLIN-CLARK
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Credential |
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Telephone | 586-718-7456
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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 | C-01284
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License Number State | MI
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