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NPI Code Detail

MEDICARE: MS. MAE FRANCES MARTIN CAC

MEDICARE: MS. MAE FRANCES MARTIN CAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1306060736
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MAE FRANCES MARTIN CAC
Provider Business Mailing Address
First Line : 9600 DEXTER ST
Second Line :
City : DETROIT
State : MI
Zip : 48206
Country : US
Telephone Number : 313-894-4879
Fax Number : 313-894-6312
Provider Business Practice Location Address
First Line : 9600 DEXTER AVE
Second Line :
City : DETROIT
State : MI
Zip : 48206-1816
Country : US
Telephone Number : 313-894-4879
Fax Number : 313-894-6312
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2007
Last Update Date : 07/08/2007

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Directions to “ MS. MAE FRANCES MARTIN CAC” Practice Location

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