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General NPI Number Information
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NPI Number | 1932574522
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Entity Type | Organization
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Legal Business Name | WOMEN AND GIRLS EMPOWERMENT CENTER LLC
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Dates
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Enumeration Date | 12/08/2015
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Last Update Date | 12/08/2015
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Provider Practice Location Address
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Address Line | 164 N MAIN ST
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City | PLYMOUTH
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State | MI
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Zip | 48170-1236
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Country | US
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Telephone | 734-656-8225
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Fax |
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Provider Business Mailing Address
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Address Line | 164 N. MAIN ST.
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City | PLYMOUTH
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State | MI
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Zip | 48170
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Country | US
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Telephone | 734-656-8225
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MELISSA PERSECHINI
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Credential | LMSW, CAADC, CTS
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Telephone | 734-656-8225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental 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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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