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General NPI Number Information
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NPI Number | 1679083372
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Entity Type | Organization
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Legal Business Name | COPE PERSONAL DEVELOPMENT CENTER
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Dates
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Enumeration Date | 10/07/2017
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Last Update Date | 10/09/2018
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Provider Practice Location Address
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Address Line | 26711 WOODWARD AVE STE LL2
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City | HUNTINGTON WOODS
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State | MI
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Zip | 48070-1370
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Country | US
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Telephone | 855-948-1661
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Fax | 888-318-6010
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Provider Business Mailing Address
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Address Line | 30016 HANOVER BLVD
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City | WESTLAND
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State | MI
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Zip | 48186-5125
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Country | US
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Telephone | 248-991-5779
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Fax | 888-318-6010
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Authorized Official
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Title or Position | PRESIDENT
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Name | TINA LARAYNE PARKMAN
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Credential | PH.D
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Telephone | 248-991-5779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 6401003666
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License Number State | MI
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