Basic Information
| Provider Information | |||||||||
| NPI: | 1922446301 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PSYCHIATRIC INTERVENTION CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 33505 SCHOOLCRAFT RD | ||||||||
| Address2: | |||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48185 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 33505 SCHOOLCRAFT RD | ||||||||
| Address2: | |||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481501630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347210200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2013 | ||||||||
| LastUpdateDate: | 06/07/2013 | ||||||||
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| AuthorizedOfficialLastName: | DIGIUSEPPE | ||||||||
| AuthorizedOfficialFirstName: | CAROL | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF PROGRAMS | ||||||||
| AuthorizedOfficialTelephone: | 7344584601 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 6801087622 | MI | Y | Agencies | Community/Behavioral Health |
No ID Information.