Healthcare Provider Details

I. General information

NPI: 1871819367
Provider Name (Legal Business Name): FRUITS OF THE SPIRIT-ELEMENTS OF YOU, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2010
Last Update Date: 04/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3660 DUNCAN RD
BENTON HARBOR MI
49022-9703
US

IV. Provider business mailing address

3660 DUNCAN RD
BENTON HARBOR MI
49022-9703
US

V. Phone/Fax

Practice location:
  • Phone: 269-927-6931
  • Fax:
Mailing address:
  • Phone: 269-927-6931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: MS. KAY LYNN LINDSAY
Title or Position: OWNER
Credential: LMSW
Phone: 269-927-6931