Provider Demographics
NPI:1396120556
Name:GUIDANCE CENTER
Entity type:Organization
Organization Name:GUIDANCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IDD AUTISM BENEFIT
Authorized Official - Prefix:MS
Authorized Official - First Name:DERRIELLE
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:734-785-7727
Mailing Address - Street 1:33635 PONDVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1471
Mailing Address - Country:US
Mailing Address - Phone:313-516-3831
Mailing Address - Fax:
Practice Address - Street 1:13101 ALLEN RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2216
Practice Address - Country:US
Practice Address - Phone:734-785-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801016587251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management