Provider Demographics
NPI:1750404463
Name:POSITIVE IMAGES
Entity type:Organization
Organization Name:POSITIVE IMAGES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE
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
Authorized Official - Phone:313-822-1148
Mailing Address - Street 1:4875 COPLIN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48215-2192
Mailing Address - Country:US
Mailing Address - Phone:313-822-1148
Mailing Address - Fax:
Practice Address - Street 1:4875 COPLIN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48215-2192
Practice Address - Country:US
Practice Address - Phone:313-822-1148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POSITIVE IMAGES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-09
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI822778251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health