Provider Demographics
NPI:1912153198
Name:BURNETT, VALERIE JANE
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:JANE
Last Name:BURNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20105 KELLY RD
Mailing Address - Street 2:APT. 3
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48225-1290
Mailing Address - Country:US
Mailing Address - Phone:313-289-2000
Mailing Address - Fax:
Practice Address - Street 1:4216 MCDOUGALL ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-1520
Practice Address - Country:US
Practice Address - Phone:313-923-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility