Individual
ILENE BISHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9605 GRAND RIVER AVE, DETROIT, MI 48204-2139
(313) 834-5930
(313) 834-4541
Mailing address
3411 S BEATRICE ST, DETROIT, MI 48217-1569
(313) 693-5756
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
11/23/2016
Last updated
11/23/2016
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