Provider Demographics
NPI:1437417805
Name:CLINICAL PERFECTION
Entity type:Organization
Organization Name:CLINICAL PERFECTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:RODERICK
Authorized Official - Last Name:FUNDERBURG
Authorized Official - Suffix:JR
Authorized Official - Credentials:LLMSW
Authorized Official - Phone:313-207-0278
Mailing Address - Street 1:35000 DRAKESHIRE LN
Mailing Address - Street 2:101
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48335-3214
Mailing Address - Country:US
Mailing Address - Phone:313-207-0278
Mailing Address - Fax:248-659-1528
Practice Address - Street 1:11457 SHOEMAKER ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-3418
Practice Address - Country:US
Practice Address - Phone:313-207-0278
Practice Address - Fax:248-659-1528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010861401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty