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General NPI Number Information
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NPI Number | 1689238818
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Entity Type | Organization
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Legal Business Name | SEAN GILES REDEMPTION THERAPEUTIC SERVICES LLC
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Dates
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Enumeration Date | 04/23/2019
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Last Update Date | 04/23/2019
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Provider Practice Location Address
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Address Line | 13160 W OUTER DR APT 123
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City | DETROIT
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State | MI
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Zip | 48223-3187
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Country | US
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Telephone | 313-978-8073
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 19398
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City | DETROIT
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State | MI
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Zip | 48219-0398
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Country | US
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Telephone | 313-978-8073
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | GENEVA ANN GILES
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Credential | LLMSW
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Telephone | 313-978-8073
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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