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Organization

MICHIGAN INSTITUTE FOR PREVENTION INTERVENTION

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. JACKIE MOORE (DIRECTOR)
(313) 579-9468
Entity
Organization

Contact information

Practice address
18530 MACK AVE, 101, GROSSE POINTE FARMS, MI 48236-3254
(313) 579-9468
Mailing address
18530 MACK AVE, 101, GROSSE POINTE FARMS, MI 48236-3254
(313) 579-9468

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
6301005272
MI

Other

Enumeration date
05/22/2007
Last updated
10/06/2008
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