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General NPI Number Information
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NPI Number | 1861862641
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Entity Type | Organization
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Legal Business Name | MICHIGAN FORENSIC INTERVENTION SERVICES
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Dates
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Enumeration Date | 10/06/2015
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Last Update Date | 10/06/2015
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Provider Practice Location Address
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Address Line | 21821 LAKEVIEW ST
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-4057
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Country | US
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Telephone | 586-945-8034
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Fax |
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Provider Business Mailing Address
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Address Line | 21821 LAKEVIEW ST
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-4057
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH COUNSELOR
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Name | VICTORIA MARION
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Credential |
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Telephone | 586-945-8034
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | SA0500473
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License Number State | MI
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