| A Path To Peace Llc | |
|
1010 Antietam Ave Detroit MI 48207-2832 | |
| (231) 343-0630 | |
| Not Available |
| Full Name | A Path To Peace Llc |
|---|---|
| Speciality | Counselor |
| Location | 1010 Antietam Ave, Detroit, Michigan |
| Authorized Official Name and Position | Melba Lynette Clark (LICENSED PROFESSIONAL COUNSELOR) |
| Authorized Official Contact | 2313430630 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| A Path To Peace Llc 9339 Pine St Taylor MI 48180-3419 Ph: (231) 343-0630 | A Path To Peace Llc 1010 Antietam Ave Detroit MI 48207-2832 Ph: (231) 343-0630 |
| NPI Number | 1083259345 |
|---|---|
| Provider Enumeration Date | 11/11/2019 |
| Last Update Date | 02/07/2020 |
| Certification Date | 02/07/2020 |
| Medicare PECOS PAC ID | 1759722317 |
|---|---|
| Medicare Enrollment ID | O20240514001115 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083259345 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Melba Clark |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1073158317 PECOS PAC ID: 4486095049 Enrollment ID: I20240514001279 |
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