Provider Demographics
NPI:1235552118
Name:NORTHEAST GUIDANCE CENTER
Entity Type:Organization
Organization Name:NORTHEAST GUIDANCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:POLICE LIAISON
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:LAMONT
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:LLBSW
Authorized Official - Phone:313-784-3336
Mailing Address - Street 1:2900 CONNOR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48203
Mailing Address - Country:US
Mailing Address - Phone:313-308-1400
Mailing Address - Fax:
Practice Address - Street 1:2900 CONNER ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48215-2407
Practice Address - Country:US
Practice Address - Phone:313-308-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68020871351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty