Healthcare Provider Details

I. General information

NPI: 1629983754
Provider Name (Legal Business Name): LUNASOL THERAPEUTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 S RIPLEY ST SUITE 5
ALPENA MI
49707
US

IV. Provider business mailing address

145 S RIPLEY ST SUITE 5
ALPENA MI
49707
US

V. Phone/Fax

Practice location:
  • Phone: 989-884-1685
  • Fax:
Mailing address:
  • Phone: 989-884-1685
  • Fax: 989-419-5990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER RENEE GRAHAM
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 989-884-1685