Organization
NORTHEAST GUIDANCE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUE NEDERLANDER (CHIEF FINANCIAL OFFICER)
(313) 824-5642
Entity
Organization
Contact information
Practice address
12800 E WARREN AVE, DETROIT, MI 48215-2061
(313) 824-8000
(313) 824-5589
Mailing address
2900 CONNER AVENUE, BLDG A, DETROIT, MI 48215
(313) 308-1400
(313) 308-1600
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21-3119549
—
MI
Enumeration date
07/26/2011
Last updated
07/26/2011
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