Provider Demographics
NPI:1063953834
Name:DAUGHTER STATUS FOUNDATION
Entity type:Organization
Organization Name:DAUGHTER STATUS FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:JOY
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:CREEL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:810-287-8822
Mailing Address - Street 1:43237 CAPE DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-2334
Mailing Address - Country:US
Mailing Address - Phone:810-287-8822
Mailing Address - Fax:
Practice Address - Street 1:24901 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 600
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2203
Practice Address - Country:US
Practice Address - Phone:810-287-8822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014431251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health