Organization
NORTHEAST GUIDANCE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SUE NEDERLANDER (CHIEF FINANCIAL OFFICE)
(313) 824-5542
Entity
Organization
Contact information
Practice address
12800 E WARREN AVE, DETROIT, MI 48215-2601
(313) 824-8000
(313) 824-5589
Mailing address
2900 CONNER AVE, BLDG A, DETROIT, MI 48215-2061
(313) 308-1400
(313) 308-1600
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104682983
—
MI
05
—
21-3119549
—
MI
01
—
750910874
BLUE CROSS BLUE SHEILD MI
MI
Enumeration date
07/01/2006
Last updated
07/26/2011
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