Organization
GENESEE COUNTY COMMUNITY MENTAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIS RUSSELL (CHIEF EXECUTIVE OFFICER)
(810) 257-3707
Entity
Organization
Contact information
Practice address
420 W 5TH AVE, FLINT, MI 48503-2445
(810) 257-3736
Mailing address
725 MASON ST, FLINT, MI 48503-2421
(810) 257-3736
Taxonomy
Speciality
Code
Description
License number
State
103TH0100X
Health Service Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
774350384
—
MI
Enumeration date
05/12/2010
Last updated
05/12/2010
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