Provider Demographics
NPI:1033455316
Name:THE CHILDRENS CENTER
Entity Type:Organization
Organization Name:THE CHILDRENS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TAJ
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-831-5535
Mailing Address - Street 1:100 WEST ALEXANDRINE ST.
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-831-5535
Mailing Address - Fax:313-262-0914
Practice Address - Street 1:100 W ALEXANDRINE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2016
Practice Address - Country:US
Practice Address - Phone:313-831-5535
Practice Address - Fax:313-262-0914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801061747251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health