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General NPI Number Information
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NPI Number | 1962988576
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Entity Type | Organization
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Legal Business Name | PAMS PLACE COUNSELING CENTER
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Dates
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Enumeration Date | 07/17/2018
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Last Update Date | 12/30/2020
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Provider Practice Location Address
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Address Line | 2441 W GRAND BLVD STE 202
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City | DETROIT
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State | MI
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Zip | 48208-1229
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Country | US
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Telephone | 313-894-8088
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Fax | 313-894-8888
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Provider Business Mailing Address
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Address Line | 2441 W GRAND BLVD STE 202
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City | DETROIT
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State | MI
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Zip | 48208-1229
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Country | US
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Telephone | 313-894-8088
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Fax | 313-894-8888
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. JAMES T EDGAR JR.
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Credential | LLPC
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Telephone | 313-894-8088
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401007590
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License Number State | MI
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