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General NPI Number Information
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NPI Number | 1780980318
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Entity Type | Organization
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Legal Business Name | CONTINUOUS INDEPENDENCE PROGRAM
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Dates
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Enumeration Date | 01/30/2011
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Last Update Date | 01/30/2011
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Provider Practice Location Address
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Address Line | 28 N FRANCIS AVE
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City | PONTIAC
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State | MI
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Zip | 48342-2721
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Country | US
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Telephone | 248-499-8022
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Fax |
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Provider Business Mailing Address
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Address Line | 28 N FRANCIS AVE
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City | PONTIAC
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State | MI
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Zip | 48342-2721
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Country | US
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Telephone | 248-499-8022
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MR. DAVID COLEMAN
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Credential | LLPC
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Telephone | 313-929-3422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 6401011745
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 6401011745
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License Number State | MI
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