Provider Demographics
NPI:1598167371
Name:THE WOMEN'S CENTER OF SOUTHEASTERN MICHIGAN
Entity Type:Organization
Organization Name:THE WOMEN'S CENTER OF SOUTHEASTERN MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEAVITT
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:734-973-6779
Mailing Address - Street 1:1100 VICTORS WAY STE 10
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-5220
Mailing Address - Country:US
Mailing Address - Phone:734-973-6779
Mailing Address - Fax:734-973-6609
Practice Address - Street 1:1100 VICTORS WAY STE 10
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-5220
Practice Address - Country:US
Practice Address - Phone:734-973-6779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-23
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010805461041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty