| Life Challenge Of Southeastern Michigan | |
|
17667 Pierson St Detroit MI 48219-2520 | |
| (313) 531-0111 | |
| Not Available |
| Full Name | Life Challenge Of Southeastern Michigan |
|---|---|
| Speciality | Counselor |
| Location | 17667 Pierson St, Detroit, Michigan |
| Authorized Official Name and Position | Ken Keene (DIRECTOR) |
| Authorized Official Contact | 3135310111 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Challenge Of Southeastern Michigan 17667 Pierson St Detroit MI 48219-2520 Ph: (313) 531-0111 | Life Challenge Of Southeastern Michigan 17667 Pierson St Detroit MI 48219-2520 Ph: (313) 531-0111 |
| NPI Number | 1205304359 |
|---|---|
| Provider Enumeration Date | 11/07/2018 |
| Last Update Date | 11/07/2018 |
| Medicare PECOS PAC ID | 3072944743 |
|---|---|
| Medicare Enrollment ID | O20200513000544 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205304359 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
| Provider Name | Mark Menestrina |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265498059 PECOS PAC ID: 8325032014 Enrollment ID: I20040414000781 |
| Provider Name | Cindy Lancaster |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265886535 PECOS PAC ID: 9739442005 Enrollment ID: I20180419000970 |
| Provider Name | Sheila Faye Brown-burrell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1235383605 PECOS PAC ID: 1759720055 Enrollment ID: I20240419000875 |
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