Provider Demographics
NPI:1063810893
Name:NORTH EAST GUIDANCE CENTER
Entity type:Organization
Organization Name:NORTH EAST GUIDANCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QUALIFIED MENTAL HEALTH PROFESSIONA
Authorized Official - Prefix:MR
Authorized Official - First Name:ALTON
Authorized Official - Middle Name:
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-308-1400
Mailing Address - Street 1:2900 CONNER ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48215-2407
Mailing Address - Country:US
Mailing Address - Phone:313-308-1400
Mailing Address - Fax:313-308-1600
Practice Address - Street 1:2900 CONNER ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48215-2407
Practice Address - Country:US
Practice Address - Phone:313-308-1400
Practice Address - Fax:313-308-1600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1922037134101YM0800X, 251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1923037134Medicaid