GRATIOT CLINIC (NPI# 1710102249) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710102249 |
| Entity Type | Organization |
| Organization Name | GRATIOT CLINIC |
| Practice Address |
3506 Gratiot Ave Detroit MI 48207-1830 |
| Practice Telephone | 3138876761 |
| Practice Fax Number | 3138524847 |
| Mailing Telephone | 3138876761 |
| Mailing Fax Number | 3138524847 |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. KENNETH DWAYNE PERRY (CLINIC SUPERVISOR) |
| Authorized Official Telephone | 3138876760 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
820522 | MI | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | STATE LICENSE | MI10142 | 01 |
| Street Address |
3506 GRATIOT AVE |
| City | DETROIT |
| State | MI |
| Zip Code | 48207-1830 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417167990 | James Howard Davis | Counselor | 3506 Gratiot Ave, Detroit, MI 48207-1830 | 2007-05-23 |
| 1770791188 | Carol Bryant | Registered Nurse | 3506 Gratiot Ave, Detroit, MI 48207-1830 | 2007-05-18 |
| 1881802296 | Noreen F Shackelford | Registered Nurse | 3506 Gratiot Ave, Detroit, MI 48207-1830 | 2007-05-18 |
| 1023230653 | Levonne Donnie Davis | Counselor | 3506 Gratiot Ave, Detroit, MI 48207-1830 | 2007-05-03 |
| 1619199254 | Barbara Ann Shearer | Counselor | 3506 Gratiot Ave, Detroit, MI 48207-1830 | 2007-05-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245848506 | Anton R Gonzales | Physical Therapy Assistant | 2295 Chene, Detroit, Mi 48207, Detroit, MI 48207 | 2020-07-22 |
| 1033733928 | Taleshia Moss | Occupational Therapist | 2295 Chene, Detroit, MI 48207 | 2020-06-05 |
| 1942858550 | Ronald Royce Cochran | Counselor | 2925 Russell St, Detroit, Detroit, MI 48207 | 2019-08-27 |
| 1649831439 | Charday Penick | Social Worker | Team Wellness, 2925 Russell St, Detroit, MI 48207 | 2019-06-24 |
| 1568023349 | Alphia Ramona Burgess | Social Worker | Team Wellness Center, 2925 Russell Street, Detroit, MI 48207 | 2019-06-24 |
| 1447741608 | Sherice Ward | Social Worker | 100 River Place Drive, Ste 250, Detroit, MI 48207 | 2018-05-23 |
| 1427549955 | Mission Point of Detroit, LLC | Skilled Nursing Facility | 2102 Orleans, Detroit, MI 48207 | 2018-05-21 |
| 1043723737 | Olivia Carter | Case Management | 2712 Gratiot, Detroit, MI 48207 | 2017-11-16 |
| 1558885590 | Kalimah Johnson | Social Worker | 701 Mcdougall, Detroit, MI 48207 | 2017-08-01 |
| 1922534692 | Angela Young | Social Worker | 100 River Place 520, Detroit, MI 48207 | 2017-05-02 |
| Find all providers in zip 48207 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386251841 | Diversified Community Services | Counselor | 10301 W 7 Mile Rd, Detroit, MI 48221-1962 | 2020-09-29 |
| 1750907853 | Ronnie Stephen | Counselor | 15025 Fenkell St, Detroit, MI 48227-2647 | 2020-06-24 |
| 1144860552 | Allen Hugh Warrick IIi | Counselor | 9605 Grand River Ave # A, Detroit, MI 48204-2139 | 2020-01-14 |
| 1396309878 | Darnesha Coy | Counselor | 17870 Dresden St, Detroit, MI 48205-3138 | 2019-04-30 |
| 1518438746 | Curron Thomas | Counselor | 16850 Wyoming St, Apartment 328, Detroit, MI 48221-3415 | 2018-12-16 |
| 1861962094 | Reid Talley | Counselor | 12010 Elmhurst, Detroit, MI 48206 | 2018-11-30 |
| 1205304359 | Life Challenge of Southeastern Michigan | Counselor | 17667 Pierson St, Detroit, MI 48219-2520 | 2018-11-07 |
| 1598233892 | Michigan Employment & Training Plus | Counselor | 6522 Piedmont St, Detroit, MI 48228-4950 | 2018-11-05 |
| 1821588773 | Avery Brown Jr. | Counselor | 8333 Townsend St, Detroit, MI 48213-2331 | 2018-05-16 |
| 1538669304 | Helping Hands Community Centers 1 | Counselor | 2434 Chicago Blvd, Detroit, MI 48206-1741 | 2018-02-17 |
| Find all providers in DETROIT | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.