Provider Demographics
NPI:1386083541
Name:AARIC CARE OUTPATIENT PROGRAM
Entity type:Organization
Organization Name:AARIC CARE OUTPATIENT PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ZIPPORAH
Authorized Official - Middle Name:K
Authorized Official - Last Name:BOLAR
Authorized Official - Suffix:
Authorized Official - Credentials:LLPC
Authorized Official - Phone:313-784-5348
Mailing Address - Street 1:17830 E WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-1332
Mailing Address - Country:US
Mailing Address - Phone:313-784-5348
Mailing Address - Fax:
Practice Address - Street 1:17830 E WARREN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-1332
Practice Address - Country:US
Practice Address - Phone:313-784-5348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI823200101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty