Provider Demographics
NPI:1417836644
Name:INNER CITY FAMILY SERVICES DETROIT LLC
Entity type:Organization
Organization Name:INNER CITY FAMILY SERVICES DETROIT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:WIKKELING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-916-6801
Mailing Address - Street 1:17894 MACK AVE STE A
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48230-6250
Mailing Address - Country:US
Mailing Address - Phone:313-909-9590
Mailing Address - Fax:
Practice Address - Street 1:17894 MACK AVE STE A
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE
Practice Address - State:MI
Practice Address - Zip Code:48230-6250
Practice Address - Country:US
Practice Address - Phone:313-909-9590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INNER CITY FAMILY SERVICES DETROIT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-09-01
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251B00000XAgenciesCase Management