Provider Demographics
NPI:1790320331
Name:FAITH HOPE & LOVE OUTREACH CENTER INC
Entity Type:Organization
Organization Name:FAITH HOPE & LOVE OUTREACH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DJUANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:COATS
Authorized Official - Suffix:
Authorized Official - Credentials:MCC
Authorized Official - Phone:313-646-6864
Mailing Address - Street 1:18284 JAMES COUZENS FWY.
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-2503
Mailing Address - Country:US
Mailing Address - Phone:313-646-6864
Mailing Address - Fax:
Practice Address - Street 1:18284 JAMES COUZENS FWY.
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-2503
Practice Address - Country:US
Practice Address - Phone:313-646-6864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-07
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty