Basic Information
| Provider Information | |||||||||
| NPI: | 1154578367 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FRIENDS OF DETROIT & TRI COUNTIES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8230 E FOREST AVE | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482141156 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 8230 E FOREST AVE | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482141156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3139240085 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2008 | ||||||||
| LastUpdateDate: | 08/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | WIMBERLY | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3139240085 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.