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Organization
GRATIOT CLINIC
Active
Organization
GRATIOT CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH DWAYNE PERRY (CLINIC SUPERVISOR)
(313) 887-6760
Entity
Organization
Contact information
Practice address
3506 GRATIOT AVE, DETROIT, MI 48207-1830
(313) 887-6761
(313) 852-4847
Mailing address
3506 GRATIOT AVE, DETROIT, MI 48207-1830
(313) 887-6761
(313) 852-4847
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
820522
MI
Other
Enumeration date
04/17/2007
Last updated
08/22/2020
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