Provider Demographics
NPI:1871866475
Name:POSITIVE IMAGES
Entity Type:Organization
Organization Name:POSITIVE IMAGES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MAISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KENYATTA
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW,CAAC
Authorized Official - Phone:313-822-6940
Mailing Address - Street 1:13336 E.WARREN
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48229
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13336 E.WARREN
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48229
Practice Address - Country:US
Practice Address - Phone:313-822-6940
Practice Address - Fax:313-822-0176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401005925324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility