Organization
LAKE HURON CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERROLYNN JUSTUSSON (PRESIDENT)
(800) 743-0396
Entity
Organization
Contact information
Practice address
2870 E GRAND BLVD STE 600, DETROIT, MI 48202-3120
(313) 736-5041
Mailing address
2870 E GRAND BLVD STE 600, DETROIT, MI 48202-3120
(313) 736-5041
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
12/18/2023
Last updated
12/18/2023
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