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Individual

KENNETH DEON BLUE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
CADCM

Contact information

Practice address
12305 DEXTER AVE, DETROIT, MI 48206-1015
(313) 397-1306
(313) 397-6010
Mailing address
12305 DEXTER AVE, DETROIT, MI 48206-1015
(313) 397-1306
(313) 397-6010

Taxonomy

Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary

Other

Enumeration date
12/28/2011
Last updated
12/28/2011
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