# MIDWEST DETOX LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316690753
- **Authorized official:** DONOVAN MISKE (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (313) 444-0167

## Contact information

- **Practice address:** 31153 PLYMOUTH RD STE 105, LIVONIA, MI 48150-2134
- **Practice address phone:** (231) 409-0606
- **Mailing address:** 31153 PLYMOUTH RD STE 105, LIVONIA, MI 48150-2134

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | Yes |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | Yes |

## Other

- **Enumeration date:** 01/26/2022
- **Last updated:** 01/26/2022