Provider Demographics
NPI:1396374617
Name:AMOS, VENUS D
Entity Type:Individual
Prefix:
First Name:VENUS
Middle Name:D
Last Name:AMOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22725 CAMBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-1725
Mailing Address - Country:US
Mailing Address - Phone:313-516-0027
Mailing Address - Fax:313-533-7877
Practice Address - Street 1:22725 CAMBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-1725
Practice Address - Country:US
Practice Address - Phone:313-516-0027
Practice Address - Fax:313-533-7877
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015418101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health