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General NPI Number Information
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NPI Number | 1922782937
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Entity Type | Organization
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Legal Business Name | SOCIAL JUSTICE LR CORP MANAGEMENT HOLDINGS
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Dates
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Enumeration Date | 06/12/2023
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Last Update Date | 06/12/2023
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Provider Practice Location Address
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Address Line | 600 TOWN CENTER DR
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City | DEARBORN
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State | MI
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Zip | 48126-2718
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Country | US
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Telephone | 501-604-3330
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Fax |
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Provider Business Mailing Address
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Address Line | 3424 LUDWIG ST
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City | LITTLE ROCK
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State | AR
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Zip | 72204-4470
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Country | US
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Telephone | 501-412-5520
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | MR. SEAN DAVIDSON
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Credential |
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Telephone | 501-604-3330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1800X
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Taxonomy Name | Corporate Health Clinic/Center
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 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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