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General NPI Number Information
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NPI Number | 1932391042
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Entity Type | Organization
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Legal Business Name | CHILDRENS HOME OF DETROIT
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 08/13/2007
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Provider Practice Location Address
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Address Line | 6902 CHICAGO RD
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City | WARREN
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State | MI
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Zip | 48092-1686
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Country | US
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Telephone | 586-939-4940
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Fax |
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Provider Business Mailing Address
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Address Line | 6902 CHICAGO RD
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City | WARREN
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State | MI
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Zip | 48092-1686
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Country | US
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Telephone | 586-939-4940
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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 | MS. MELVINE M MILLER
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Credential | MA LMSW
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Telephone | 586-939-4940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 500439
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License Number State | MI
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