Organization
CONTINUOUS INDEPENDENCE PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID COLEMAN LLPC (CLINICAL DIRECTOR)
(313) 929-3422
Entity
Organization
Contact information
Practice address
28 N FRANCIS AVE, PONTIAC, MI 48342-2721
(248) 499-8022
Mailing address
28 N FRANCIS AVE, PONTIAC, MI 48342-2721
(248) 499-8022
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
6401011745
MI
324500000X
Substance Abuse Rehabilitation Facility
6401011745
MI
Other
Enumeration date
01/30/2011
Last updated
01/30/2011
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