Provider Demographics
NPI:1497179170
Name:DETROIT WAYNE MENTAL HEALTH AUTHORITY
Entity Type:Organization
Organization Name:DETROIT WAYNE MENTAL HEALTH AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DURANT
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:313-344-9099
Mailing Address - Street 1:707 W. MILWAUKEE
Mailing Address - Street 2:3RD FLOOR FINANCE
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:707 W. MILWAUKEE
Practice Address - Street 2:3RD FLOOR FINANCE
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2599
Practice Address - Country:US
Practice Address - Phone:313-344-9099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-14
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Single Specialty