Provider Demographics
NPI:1679083372
Name:COPE PERSONAL DEVELOPMENT CENTER
Entity Type:Organization
Organization Name:COPE PERSONAL DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:LARAYNE
Authorized Official - Last Name:PARKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-991-5779
Mailing Address - Street 1:30016 HANOVER BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-5125
Mailing Address - Country:US
Mailing Address - Phone:248-991-5779
Mailing Address - Fax:888-318-6010
Practice Address - Street 1:26711 WOODWARD AVE STE LL2
Practice Address - Street 2:
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070-1370
Practice Address - Country:US
Practice Address - Phone:855-948-1661
Practice Address - Fax:888-318-6010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-07
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401003666101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1548462591Medicaid
MI1184926446Medicaid
MI1477876019Medicaid
MI1851752596Medicaid