Provider Demographics
NPI:1790523462
Name:DEMBRO OUTPATIENT SERVICES OF MICHIGAN
Entity type:Organization
Organization Name:DEMBRO OUTPATIENT SERVICES OF MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATOT
Authorized Official - Prefix:MS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LAC, NCC
Authorized Official - Phone:313-575-9629
Mailing Address - Street 1:2021 MONROE ST STE 303
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2926
Mailing Address - Country:US
Mailing Address - Phone:313-800-9266
Mailing Address - Fax:313-490-1516
Practice Address - Street 1:2021 MONROE ST STE 303
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2926
Practice Address - Country:US
Practice Address - Phone:313-800-9266
Practice Address - Fax:313-490-1516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)