Provider Demographics
NPI:1255726592
Name:ALLIANCE FOR HOPE AND HEALING
Entity type:Organization
Organization Name:ALLIANCE FOR HOPE AND HEALING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:DWAYNE
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:734-664-2528
Mailing Address - Street 1:8005 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MI
Mailing Address - Zip Code:48130-1027
Mailing Address - Country:US
Mailing Address - Phone:734-664-2528
Mailing Address - Fax:
Practice Address - Street 1:8005 MAIN ST.
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MI
Practice Address - Zip Code:48130
Practice Address - Country:US
Practice Address - Phone:734-664-2528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012432103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty