Provider Demographics
NPI:1952431777
Name:METROPOLITAN ARTS COMPLEX INC
Entity Type:Organization
Organization Name:METROPOLITAN ARTS COMPLEX INC
Other - Org Name:METRO ARTS THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR & CLINICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMELITA
Authorized Official - Middle Name:LEVON
Authorized Official - Last Name:MANDINGO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, ADS, CHT, CADCM
Authorized Official - Phone:313-863-5554
Mailing Address - Street 1:11000 W. MCNICHOLS
Mailing Address - Street 2:SUITE B3 & B4
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-2357
Mailing Address - Country:US
Mailing Address - Phone:313-863-5554
Mailing Address - Fax:313-863-4711
Practice Address - Street 1:11000 W. MCNICHOLS
Practice Address - Street 2:SUITE B3 & B4
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221
Practice Address - Country:US
Practice Address - Phone:313-863-5554
Practice Address - Fax:313-863-4711
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METROPOLITAN ARTS COMPLEX INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-07
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010525101YA0400X, 101YP2500X, 261QM0850X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI31-3204514Medicaid