Provider Demographics
NPI:1962884080
Name:SERVICES TO ENHANCE POTENTIAL
Entity type:Organization
Organization Name:SERVICES TO ENHANCE POTENTIAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESOURCE CENTER DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMARIA
Authorized Official - Middle Name:LASHAWN
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-267-9777
Mailing Address - Street 1:4700 BEAUFAIT ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-1372
Mailing Address - Country:US
Mailing Address - Phone:313-267-9777
Mailing Address - Fax:313-921-9131
Practice Address - Street 1:4700 BEAUFAIT ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-1372
Practice Address - Country:US
Practice Address - Phone:313-267-9777
Practice Address - Fax:313-921-9131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management