Organization
ELISHA ETIENNE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. FRANCINE JACKSON LMSW (OWNER)
(734) 985-3085
Entity
Organization
Contact information
Practice address
4720 ROMEO LN, NORTHVILLE, MI 48167-8699
(734) 985-3085
Mailing address
4720 ROMEO LN, NORTHVILLE, MI 48167-8699
(734) 985-3085
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
03/20/2020
Last updated
03/20/2020
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