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1220 6th St Port Huron MI 48060-5349 | |
| (810) 987-8772 | |
| (810) 987-8706 |
| Full Name | |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 1220 6th St, Port Huron, Michigan |
| Authorized Official Name and Position | Ernestine Kimberly Brown (CLINICAL DIRECTOR) |
| Authorized Official Contact | 8109878772 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1220 6th St Port Huron MI 48060-5349 Ph: (810) 987-8772 | 1220 6th St Port Huron MI 48060-5349 Ph: (810) 987-8772 |
| NPI Number | 1568822971 |
|---|---|
| Provider Enumeration Date | 02/26/2016 |
| Last Update Date | 02/26/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568822971 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 6801086434 (Michigan) | Primary |
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