Provider Demographics
NPI:1689045106
Name:DETROIT RECOVERY PROJECT, INCORPORATED
Entity Type:Organization
Organization Name:DETROIT RECOVERY PROJECT, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIRDELL
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW,LMSW,CAADC,CCS,
Authorized Official - Phone:313-365-3113
Mailing Address - Street 1:1121 E MCNICHOLS RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48203-2857
Mailing Address - Country:US
Mailing Address - Phone:313-365-3113
Mailing Address - Fax:313-365-3098
Practice Address - Street 1:400 CORTLAND ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:MI
Practice Address - Zip Code:48203-3437
Practice Address - Country:US
Practice Address - Phone:313-365-3100
Practice Address - Fax:313-365-3101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISA0823062251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health