# MANNA OF DETROIT INC.

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

## Provider details

- **NPI number:** 1629050471
- **Authorized official:** MR. MARVIN CHILES THOMAS MA CACII NCGC SWT (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (313) 491-2956

## Contact information

- **Practice address:** 12048 GRAND RIVER AVE, DETROIT, MI 48204-1836
- **Practice address phone:** (313) 491-2956
- **Practice address fax:** (313) 491-0616
- **Mailing address:** PO BOX 20696, 12048 GRAND RIVER, DET.MI 48204, FERNDALE, MI 48220-0696
- **Mailing address phone:** (313) 491-2956
- **Mailing address fax:** (313) 491-0616

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | 822416 | MI | Yes |

## Other

- **Enumeration date:** 11/17/2005
- **Last updated:** 08/22/2020