Provider Demographics
NPI:1629476379
Name:NORTHEAST GUIDANCE CENTER
Entity Type:Organization
Organization Name:NORTHEAST GUIDANCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACT ADVOCATE
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:LAMONT
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-784-3336
Mailing Address - Street 1:661 COVINGTON DR APT B6
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48203-3834
Mailing Address - Country:US
Mailing Address - Phone:313-784-3336
Mailing Address - Fax:
Practice Address - Street 1:12800 WARREN
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48215
Practice Address - Country:US
Practice Address - Phone:313-824-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI680208715251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health