Provider Demographics
NPI:1174803571
Name:DETROIT FAMILY CENTER, LLC
Entity type:Organization
Organization Name:DETROIT FAMILY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCELLA
Authorized Official - Middle Name:MAREA
Authorized Official - Last Name:PAYNE CHARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LLPC, CAADC
Authorized Official - Phone:313-208-9947
Mailing Address - Street 1:24564 RAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-1408
Mailing Address - Country:US
Mailing Address - Phone:313-525-0142
Mailing Address - Fax:
Practice Address - Street 1:24564 RAVEN AVE
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-1408
Practice Address - Country:US
Practice Address - Phone:313-525-0142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009381251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health