Individual
CARLOS T LEAGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
445 LEDYARD ST, DETROIT, MI 48201-2641
(313) 962-9446
(313) 962-6395
Mailing address
445 LEDYARD ST, DETROIT, MI 48201-2641
(313) 962-9446
(313) 962-6395
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
DEVELOPMENTPLAN
MI
Other
Enumeration date
07/23/2012
Last updated
07/23/2012
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