Provider Demographics
NPI:1114144847
Name:COUNTY OF WAYNE
Entity Type:Organization
Organization Name:COUNTY OF WAYNE
Other - Org Name:THIRD CIRCUIT COURT-CLINIC FOR CHILD STUDY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CLINIC OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ESTERBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LMSW
Authorized Official - Phone:313-833-2830
Mailing Address - Street 1:1025 E FOREST AVE
Mailing Address - Street 2:BUILDING C
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-1024
Mailing Address - Country:US
Mailing Address - Phone:313-833-2800
Mailing Address - Fax:313-833-2841
Practice Address - Street 1:1025 E FOREST AVE
Practice Address - Street 2:BUILDING C
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-1024
Practice Address - Country:US
Practice Address - Phone:313-833-2800
Practice Address - Fax:313-833-2841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health