NPIMap

Organization Active NPI

Gratiot Clinic

  • Addiction (Substance Use Disorder) Counselor
  • Detroit, MI
National Provider Identifier
1710102249
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
820522 Issued in MI
Legal business name
GRATIOT CLINIC
Practice address
3506 Gratiot Ave
Detroit, MI 48207-1830
Phone
(313) 887-6761
Fax
(313) 852-4847
NPI assigned
Apr 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Kenneth Dwayne Perry
Title
Clinic Supervisor
Phone
(313) 887-6760

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YA0400X 820522 MI Primary

Addresses

Primary practice location

3506 Gratiot Ave
Detroit, MI 48207-1830

Mailing address

3506 Gratiot Ave
Detroit, MI 48207-1830
Phone (313) 887-6761

Other identifiers 1

IdentifierTypeStateIssuer
MI10142OtherMISTATE LICENSE

National Provider Directory

National Provider Directory

Locations

3506 Gratiot Ave
Detroit, MI 48207
Phone (313) 887-6757

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1710102249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3506 GRATIOT AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482071830",
            "telephone_number": "313-887-6761",
            "fax_number": "313-852-4847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3506 GRATIOT AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482071830",
            "telephone_number": "313-887-6761",
            "fax_number": "313-852-4847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRATIOT CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PERRY",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "DWAYNE",
        "authorized_official_title_or_position": "CLINIC SUPERVISOR",
        "authorized_official_telephone_number": "313-887-6760",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MI",
            "license": "820522",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "MI10142",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.