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General NPI Number Information
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NPI Number | 1871018788
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Entity Type | Organization
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Legal Business Name | CHANGING LIVES AND STAYING SOBER
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Dates
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Enumeration Date | 08/11/2017
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Last Update Date | 05/21/2023
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Provider Practice Location Address
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Address Line | 17405 LAHSER RD
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City | DETROIT
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State | MI
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Zip | 48219-2334
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Country | US
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Telephone | 313-412-2160
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Fax |
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Provider Business Mailing Address
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Address Line | 17405 LAHSER RD
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City | DETROIT
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State | MI
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Zip | 48219-2334
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Country | US
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Telephone | 313-412-2160
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Fax |
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | DR. KARLA MITCHELL
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Credential | ND
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Telephone | 313-784-0202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 202D00000X
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Taxonomy Name | Integrative Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | SA0822584
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License Number State | MI
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