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General NPI Number Information
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NPI Number | 1952431777
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Entity Type | Organization
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Legal Business Name | METROPOLITAN ARTS COMPLEX INC
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 10/26/2018
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Provider Practice Location Address
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Address Line | 11000 W. MCNICHOLS SUITE B3 & B4
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City | DETROIT
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State | MI
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Zip | 48221
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Country | US
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Telephone | 313-863-5554
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Fax | 313-863-4711
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Provider Business Mailing Address
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Address Line | 11000 W. MCNICHOLS SUITE B3 & B4
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City | DETROIT
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State | MI
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Zip | 48221-2357
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Country | US
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Telephone | 313-863-5554
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Fax | 313-863-4711
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR & CLINICIAN
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Name | MRS. AMELITA LEVON MANDINGO
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Credential | PHD, ADS, CHT, CADCM
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Telephone | 313-863-5554
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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 | 6401010525
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License Number State | MI
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401010525
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 6401010525
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License Number State | MI
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