Street Life Recovery Program

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

STREET LIFE RECOVERY PROGRAM

Practice address

14703 Allen Rd Ste 104
Southgate, MI 48195-2594

Phone

(734) 496-5599

NPI assigned

Feb 26, 2024

Organization subpart

No

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

Authorized official

Name

Edward Ian Robinson, PEER SUPPORT

Title

Executive Director

Phone

(734) 262-2753

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1708905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754524800000",
    "number": "1982460234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14703 ALLEN RD STE 104",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481952594",
            "telephone_number": "734-262-2753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14703 ALLEN RD STE 104",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481952594",
            "telephone_number": "734-496-5599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STREET LIFE RECOVERY PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-26",
        "last_updated": "2025-08-07",
        "certification_date": "2025-08-07",
        "status": "A",
        "authorized_official_last_name": "ROBINSON",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "IAN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "734-262-2753",
        "authorized_official_credential": "PEER SUPPORT"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Southgate, MI
• Providers in Southgate, MI by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2025; 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.