Provider Demographics
NPI:1528473766
Name:CHILD SAFE MICHIGAN
Entity type:Organization
Organization Name:CHILD SAFE MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LESNIAK
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:248-353-0921
Mailing Address - Street 1:30680 MONTPELIER DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-1802
Mailing Address - Country:US
Mailing Address - Phone:248-353-0921
Mailing Address - Fax:248-307-9595
Practice Address - Street 1:30680 MONTPELIER DR
Practice Address - Street 2:SUITE 250
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1802
Practice Address - Country:US
Practice Address - Phone:248-353-0921
Practice Address - Fax:248-307-9595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801074061251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health