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General NPI Number Information
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NPI Number | 1639491186
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Entity Type | Organization
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Legal Business Name | CHIRSTIAN GUIDANCE CENTER
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Dates
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Enumeration Date | 02/25/2010
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Last Update Date | 02/25/2010
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Provider Practice Location Address
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Address Line | 91 GLENDALE ST
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City | HIGHLAND PARK
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State | MI
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Zip | 48203-3274
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Country | US
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Telephone | 313-263-0077
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Fax | 313-883-0422
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Provider Business Mailing Address
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Address Line | 6480 SHERWOOD ST
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City | DETROIT
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State | MI
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Zip | 48211-2476
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Country | US
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Telephone | 313-525-8987
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Fax | 313-883-0422
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Authorized Official
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Title or Position | CLINICAL SUPERVISOR
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Name | MR. DENNIS CRAWFORD
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Credential |
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Telephone | 313-263-0077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 251B00000X
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License Number State | MI
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