Provider Demographics
NPI:1417104498
Name:INNERVISIONS OF MICHIGAN
Entity Type:Organization
Organization Name:INNERVISIONS OF MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAPRICE
Authorized Official - Middle Name:ELLENE
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CRC
Authorized Official - Phone:313-399-1740
Mailing Address - Street 1:8426 PIERSON ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-2830
Mailing Address - Country:US
Mailing Address - Phone:313-399-1740
Mailing Address - Fax:
Practice Address - Street 1:8426 PIERSON ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-2830
Practice Address - Country:US
Practice Address - Phone:313-399-1740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009466251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health