Provider Demographics
NPI:1841313764
Name:ABBOTT ROAD CENTER FOR THE FAMILY
Entity type:Organization
Organization Name:ABBOTT ROAD CENTER FOR THE FAMILY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:YUSUF
Authorized Official - Middle Name:NA
Authorized Official - Last Name:ABDULLAH
Authorized Official - Suffix:
Authorized Official - Credentials:MED,LSMW
Authorized Official - Phone:517-351-2590
Mailing Address - Street 1:921 ABBOTT RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-3170
Mailing Address - Country:US
Mailing Address - Phone:517-351-2590
Mailing Address - Fax:517-351-2733
Practice Address - Street 1:921 ABBOTT RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-3170
Practice Address - Country:US
Practice Address - Phone:517-351-2590
Practice Address - Fax:517-351-2733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801058299101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty