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General NPI Number Information
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NPI Number | 1720562697
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Entity Type | Organization
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Legal Business Name | CDAGAPE
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Dates
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Enumeration Date | 09/18/2018
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Last Update Date | 02/27/2024
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Provider Practice Location Address
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Address Line | 1098 ANN ARBOR RD W
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City | PLYMOUTH
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State | MI
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Zip | 48170-2129
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Country | US
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Telephone | 248-978-5862
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Fax |
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Provider Business Mailing Address
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Address Line | 1098 ANN ARBOR RD W
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City | PLYMOUTH
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State | MI
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Zip | 48170-2129
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Country | US
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Telephone | 248-978-5862
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER/ CEO
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Name | MR. DAVID RONALD ADAMS JR.
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Credential | LPC
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Telephone | 313-715-9577
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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