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General NPI Number Information
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NPI Number | 1659729507
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Entity Type | Organization
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Legal Business Name | MICHIGAN DIAGNOSTIC ALCOHOL AND DRUG SERVICES LLC
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Dates
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Enumeration Date | 06/01/2016
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Last Update Date | 08/17/2016
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Provider Practice Location Address
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Address Line | 2449 E 12 MILE RD
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City | WARREN
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State | MI
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Zip | 48092-5647
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Country | US
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Telephone | 586-510-4992
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Fax | 586-393-5012
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Provider Business Mailing Address
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Address Line | 2449 E 12 MILE RD
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City | WARREN
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State | MI
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Zip | 48092-5647
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Country | US
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Telephone | 586-510-4992
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Fax | 586-393-5012
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Authorized Official
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Title or Position | OWNER
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Name | MR. KUMAR GIRI
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Credential |
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Telephone | 586-943-7390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #3
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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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