Individual
MRS. ILLENE RITA BOSLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CAC-I
Contact information
Practice address
13220 WOODWARD AVE, HIGHLAND PARK, MI 48203-3610
(313) 868-1946
Mailing address
150 STIMSON ST, DETROIT, MI 48201-2410
(313) 993-4700
(313) 993-6603
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
104259
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1063545556
GENESIS HOUSE III
MI
01
—
1740313238
CHRISTIAN GUIDANCE CENTER
MI
05
—
3022440
—
MI
Enumeration date
03/27/2007
Last updated
07/09/2007
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