Provider Demographics
NPI:1639491186
Name:CHIRSTIAN GUIDANCE CENTER
Entity Type:Organization
Organization Name:CHIRSTIAN GUIDANCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-263-0077
Mailing Address - Street 1:6480 SHERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48211-2476
Mailing Address - Country:US
Mailing Address - Phone:313-525-8987
Mailing Address - Fax:313-883-0422
Practice Address - Street 1:91 GLENDALE ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:MI
Practice Address - Zip Code:48203-3274
Practice Address - Country:US
Practice Address - Phone:313-263-0077
Practice Address - Fax:313-883-0422
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DETROIT RESCUE MISSION MINISTRIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251B00000X251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management