Organization
THERAPEUTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEIDRE VIAN GOLDSMITH CRNA (PROGRAM DIRECTOR)
(248) 525-6832
Entity
Organization
Contact information
Practice address
1010 E WEST MAPLE RD STE 200, WALLED LAKE, MI 48390-3571
(248) 970-1602
(734) 384-3222
Mailing address
1010 E WEST MAPLE RD STE 200, WALLED LAKE, MI 48390-3571
(248) 970-1602
(734) 384-3222
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM2800X
Methadone Clinic
Primary
SA0631371
MI
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Enumeration date
05/08/2015
Last updated
04/29/2024
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