Organization
LIFE CHALLENGE OF SOUTHEASTERN MICHIGAN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEN KEENE MDIV (DIRECTOR)
(313) 531-0111
Entity
Organization
Contact information
Practice address
17667 PIERSON ST, DETROIT, MI 48219-2520
(313) 531-0111
Mailing address
17667 PIERSON ST, DETROIT, MI 48219-2520
(313) 531-0111
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
11/07/2018
Last updated
11/07/2018
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