Individual
LONDON ASBURY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
18983 HAMBURG ST, DETROIT, MI 48205-2146
(517) 275-2704
Mailing address
17323 WILDEMERE ST, DETROIT, MI 48221-2722
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
88-3339434
—
MI
Enumeration date
01/27/2023
Last updated
01/27/2023
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