Provider Demographics
NPI:1033553128
Name:SOUTH CENTRAL MICHIGAN SUBSTANCE ABUSE COMMISSION MINORITY PROGRAM SER
Entity Type:Organization
Organization Name:SOUTH CENTRAL MICHIGAN SUBSTANCE ABUSE COMMISSION MINORITY PROGRAM SER
Other - Org Name:SUBSTANCE ABUSE PREVENTION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BONNER
Authorized Official - Suffix:SR
Authorized Official - Credentials:MCBAP CERTIFIED
Authorized Official - Phone:517-629-2113
Mailing Address - Street 1:600 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:MI
Mailing Address - Zip Code:49224-1849
Mailing Address - Country:US
Mailing Address - Phone:517-629-2113
Mailing Address - Fax:517-905-5963
Practice Address - Street 1:600 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:MI
Practice Address - Zip Code:49224-1849
Practice Address - Country:US
Practice Address - Phone:517-629-2113
Practice Address - Fax:517-905-5963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1020SAPSOtherSUBSTANCE ABUSE PREVENTION MCBAP CERTIFIED