Organization
MANIFEST THIRTY-ONE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TAJANAE DEANN FORD (OWNER/OUTPATIENT THERAPIST)
(313) 378-8418
Entity
Organization
Contact information
Practice address
19353 SAN JUAN DR, DETROIT, MI 48221-1713
(313) 378-8418
Mailing address
19353 SAN JUAN DR, DETROIT, MI 48221-1713
(313) 378-8418
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
12/10/2021
Last updated
12/10/2021
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