Individual
ELLAINA RENEE RUDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12501 HAMILTON AVE, HIGHLAND PARK, MI 48203-3243
(313) 865-1580
Mailing address
1989 VIRGINIA PARK ST, DETROIT, MI 48206-2421
(313) 784-6761
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
MI
Other
Enumeration date
08/09/2018
Last updated
08/09/2018
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