MEDICARE: TRUE TESTING ALCOHOL & DRUG LLC

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
1	104100000X	Social Worker	6802079555	MI
2	101YP2500X	Professional Counselor	6401011475	MI

General Provider Information

NPI Number	:	1427417476
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRUE TESTING ALCOHOL & DRUG LLC

Provider Business Mailing Address
First Line	:	13310 W MCNICHOLS RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-4121
Country	:	US
Telephone Number	:	313-279-0460
Fax Number	:	313-279-0463

Provider Business Practice Location Address
First Line	:	13310 W MCNICHOLS RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-4121
Country	:	US
Telephone Number	:	313-279-0460
Fax Number	:	313-279-0463

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MR. KENNETH CALHOUN
Credential	:	MA/LBSW/LLPC
Telephone Number	:	313-279-0460

Provider Enumeration Date	:	02/18/2016
Last Update Date	:	02/18/2016

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