Provider Demographics
NPI:1285359125
Name:RADICAL CONNECTIONS
Entity type:Organization
Organization Name:RADICAL CONNECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SALISBURY
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, CAADC
Authorized Official - Phone:248-919-8653
Mailing Address - Street 1:3810 PACKARD ST STE 220
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-2366
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:855-610-2294
Practice Address - Street 1:3810 PACKARD ST STE 220
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-2366
Practice Address - Country:US
Practice Address - Phone:248-919-8653
Practice Address - Fax:855-610-2294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-04
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty