Provider Demographics
NPI:1659729507
Name:MICHIGAN DIAGNOSTIC ALCOHOL AND DRUG SERVICES LLC
Entity Type:Organization
Organization Name:MICHIGAN DIAGNOSTIC ALCOHOL AND DRUG SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:GIRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-943-7390
Mailing Address - Street 1:2449 E 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-5647
Mailing Address - Country:US
Mailing Address - Phone:586-510-4992
Mailing Address - Fax:586-393-5012
Practice Address - Street 1:2449 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-5647
Practice Address - Country:US
Practice Address - Phone:586-510-4992
Practice Address - Fax:586-393-5012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-01
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty