Provider Demographics
NPI:1255410023
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:
Authorized Official - First Name:MAISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KENYATTA
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:313-822-6940
Mailing Address - Street 1:13340 E WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48215-2112
Mailing Address - Country:US
Mailing Address - Phone:313-822-6940
Mailing Address - Fax:313-822-6946
Practice Address - Street 1:13340 E WARREN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48215-2112
Practice Address - Country:US
Practice Address - Phone:313-822-6940
Practice Address - Fax:313-822-6946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MI822778324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Not Answered324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility