Organization
NCADD-IMPACT ADOLESCENT HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LAVERNE DENISE MCGLOTHIAN FOADP (OFFICE MANAGER)
(313) 921-8102
Entity
Organization
Contact information
Practice address
5555 CONNER ST, 2000 NORTH, DETROIT, MI 48213-3448
(313) 921-8102
(313) 921-4184
Mailing address
488 FRAZIER ST, RIVER ROUGE, MI 48218-1025
(313) 551-3815
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
C1820235935
MI
Other
Enumeration date
05/02/2007
Last updated
08/14/2008
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