Provider Demographics
NPI:1720130461
Name:ADULT & FAMILY SERVICES
Entity Type:Organization
Organization Name:ADULT & FAMILY SERVICES
Other - Org Name:THE GUIDANCE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:734-287-1500
Mailing Address - Street 1:19291 NORTHLINE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2220
Mailing Address - Country:US
Mailing Address - Phone:734-287-1500
Mailing Address - Fax:
Practice Address - Street 1:19291 NORTHLINE RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2220
Practice Address - Country:US
Practice Address - Phone:734-287-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010602221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty