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General NPI Number Information
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NPI Number | 1790873347
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Entity Type | Organization
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Legal Business Name | TRANSITIONAL LIFESTYLES COMMUNITY, INC
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 01/19/2011
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Provider Practice Location Address
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Address Line | 115 W 5TH AVE SUITE 1
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City | FLINT
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State | MI
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Zip | 48503-2472
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Country | US
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Telephone | 810-908-7320
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Fax | 810-877-6453
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Provider Business Mailing Address
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Address Line | PO BOX 310365
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City | FLINT
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State | MI
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Zip | 48531-0365
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Country | US
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Telephone | 810-908-7320
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DEBORAH ANN BROOKS
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Credential | LMSW, ACSW,CAAC,QSAP
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Telephone | 810-908-7320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801082709
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 250346
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License Number State | MI
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