Provider Demographics
NPI:1750892337
Name:ASD LATINOS UNLIMITED LLC
Entity type:Organization
Organization Name:ASD LATINOS UNLIMITED LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOCELIN
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:HENRIQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:248-254-2616
Mailing Address - Street 1:27856 LENOX AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-2730
Mailing Address - Country:US
Mailing Address - Phone:248-254-2616
Mailing Address - Fax:
Practice Address - Street 1:51111 WOODWARD AVE STE 150
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-5037
Practice Address - Country:US
Practice Address - Phone:248-977-5310
Practice Address - Fax:248-920-0386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-23
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty