Provider Demographics
NPI:1063754612
Name:ROWE, JAICE COLIE III
Entity type:Individual
Prefix:
First Name:JAICE
Middle Name:COLIE
Last Name:ROWE
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4209 PASADENA ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48238-2656
Mailing Address - Country:US
Mailing Address - Phone:270-901-9524
Mailing Address - Fax:313-867-0706
Practice Address - Street 1:12007 LINWOOD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-1107
Practice Address - Country:US
Practice Address - Phone:313-867-1090
Practice Address - Fax:313-867-0706
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-21
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor