| Gratiot Clinic | |
|
3506 Gratiot Ave Detroit MI 48207-1830 | |
| (313) 887-6761 | |
| (313) 852-4847 |
| Full Name | Gratiot Clinic |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 3506 Gratiot Ave, Detroit, Michigan |
| Authorized Official Name and Position | Kenneth Dwayne Perry (CLINIC SUPERVISOR) |
| Authorized Official Contact | 3138876760 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gratiot Clinic 3506 Gratiot Ave Detroit MI 48207-1830 Ph: (313) 887-6761 | Gratiot Clinic 3506 Gratiot Ave Detroit MI 48207-1830 Ph: (313) 887-6761 |
| NPI Number | 1710102249 |
|---|---|
| Provider Enumeration Date | 04/17/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710102249 | NPI | - | NPPES |
| MI10142 | Other | MI | STATE LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 820522 (Michigan) | Primary |
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