Provider Demographics
NPI:1578952081
Name:THE SOCIAL SUPPORT NETWORK
Entity Type:Organization
Organization Name:THE SOCIAL SUPPORT NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAZMIN
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:248-996-4706
Mailing Address - Street 1:27300 FRANKLIN RD APT 515
Mailing Address - Street 2:NONE
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-2309
Mailing Address - Country:US
Mailing Address - Phone:248-996-4706
Mailing Address - Fax:734-480-8831
Practice Address - Street 1:27300 FRANKLIN RD APT 515
Practice Address - Street 2:NONE
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-2309
Practice Address - Country:US
Practice Address - Phone:248-996-4706
Practice Address - Fax:734-480-8831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801094505251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health