Provider Demographics
NPI:1922782937
Name:SOCIAL JUSTICE LR CORP MANAGEMENT HOLDINGS
Entity Type:Organization
Organization Name:SOCIAL JUSTICE LR CORP MANAGEMENT HOLDINGS
Other - Org Name:SOCIAL JUSTICE LR CORP BEHAVIORAL HEALTH UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-604-3330
Mailing Address - Street 1:3424 LUDWIG ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-4470
Mailing Address - Country:US
Mailing Address - Phone:501-412-5520
Mailing Address - Fax:
Practice Address - Street 1:600 TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2718
Practice Address - Country:US
Practice Address - Phone:501-604-3330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health