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Organization

REPAIRER OF THE BREACH COUNSELING AND CONSULTANT SERVICES, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. YVONNE BROOKS LCSW (LEAD CLINICIAN)
(313) 451-4239
Entity
Organization

Contact information

Practice address
319 CHANDLER ST, DETROIT, MI 48202-2857
(313) 451-4239
Mailing address
319 CHANDLER ST, DETROIT, MI 48202-2857
(313) 451-4239

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
251S00000X
Community/Behavioral Health Agency
261QM0850X
Adult Mental Health Clinic/Center
261QM0855X
Adolescent and Children Mental Health Clinic/Center

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1184962763
NPI
Enumeration date
01/11/2019
Last updated
01/12/2023
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