Individual
MR. CLARENCE V POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9605 GRAND RIVER AVE, DETROIT, MI 48204-2139
(313) 834-5930
(313) 834-4541
Mailing address
18436 WISCONSIN ST, DETROIT, MI 48221-2063
(313) 469-2064
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
382036469
—
MI
Enumeration date
03/30/2007
Last updated
12/19/2012
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