Individual
MISS MARLEN THERSHIA EASTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CADCM
Contact information
Practice address
2081 W GRAND BLVD, DETROIT, MI 48208-1105
(313) 895-0500
(313) 895-9503
Mailing address
2081 W GRAND BLVD, DETROIT, MI 48208-1105
(313) 895-0500
(313) 895-9503
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
820123
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
820123
SUBSTANCE ABUSE LICENCE
MI
Enumeration date
05/23/2011
Last updated
05/23/2011
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