Organization
CLINICAL PERFECTION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GERALD RODERICK FUNDERBURG JR. LLMSW (PRESIDENT)
(313) 207-0278
Entity
Organization
Contact information
Practice address
11457 SHOEMAKER ST, DETROIT, MI 48213-3418
(313) 207-0278
(248) 659-1528
Mailing address
35000 DRAKESHIRE LN, 101, FARMINGTON, MI 48335-3214
(313) 207-0278
(248) 659-1528
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6801086140
MI
Other
Enumeration date
04/24/2012
Last updated
04/24/2012
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