Organization
COUNTY OF GENESEE OFFICE OF CONTROLLER
Active
Other names
Genesee County Community Mental Health
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANIS RUSSELL (CHIEF EXECUTIVE OFFICER)
(810) 257-3707
Entity
Organization
Contact information
Practice address
420 W 5TH AVE, FLINT, MI 48503
(810) 257-3736
(810) 257-3785
Mailing address
420 W 5TH AVE, FLINT, MI 48503
(810) 257-3736
(810) 257-3785
Taxonomy
Speciality
Code
Description
License number
State
2083P0901X
Public Health & General Preventive Medicine Physician
Primary
ME0100974
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2125345
—
MI
05
—
2747864
—
MI
05
—
3283410
—
MI
05
—
4166893
—
MI
05
—
4279879
—
MI
05
—
4422456
—
MI
05
—
4611319
—
MI
05
—
4643653
—
MI
05
—
4691230
—
MI
05
—
5101679
—
MI
Enumeration date
12/20/2005
Last updated
08/22/2020
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