Organization
DEVELOPMENT CENTERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CATHERINE L LIESMAN PH.D. (CHIEF EXECUTIVE OFFICER)
(313) 531-2500
Entity
Organization
Contact information
Practice address
24424 W MCNICHOLS RD, DETROIT, MI 48219-3653
(313) 255-0900
Mailing address
17421 TELEGRAPH RD, DETROIT, MI 48219-3165
(313) 531-2500
(313) 255-3465
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
260Q276040
BCBS - DOCTOR GROUP
—
01
—
750910618
BCBSM STATE EMPL ADULT
—
01
—
800H217310
BCBS - CSW GROUP
—
01
—
P94406
BLUE CARE NETWORK
—
Enumeration date
10/07/2014
Last updated
10/18/2019
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