Organization
THE ADULT PSYCHIATRIC CLINIC
Active
Other names
North Central Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM H. PEABODY MA, CSW (CHIEF EXECUTIVE OFFICER)
(313) 369-1717
Entity
Organization
Contact information
Practice address
17141 RYAN RD, DETROIT, MI 48212-1112
(313) 369-1717
(313) 369-1728
Mailing address
17141 RYAN RD, DETROIT, MI 48212-1112
(313) 369-1717
(313) 892-0137
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
1706446
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1706446
—
MI
01
—
71020000H26282
BLUE CROSS BLUE SHIELD ID
MI
Enumeration date
07/28/2006
Last updated
02/13/2013
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