Organization
VICTORY CLINICAL SERVICES LANSING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID BLANKENSHIP (PROGRAM DIRECTOR)
(517) 394-7867
Entity
Organization
Contact information
Practice address
4902 S CEDAR ST, LANSING, MI 48910-5474
(517) 394-7867
(517) 394-7869
Mailing address
4902 S CEDAR ST, LANSING, MI 48910-5474
(517) 394-7867
(517) 394-7869
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
330330
MI
261QM2800X
Methadone Clinic
Primary
330330
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MI 10046M
OTP - SAMHSA #
MI
Enumeration date
05/26/2009
Last updated
03/22/2012
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