Healthcare Provider Details

I. General information

NPI: 1649003997
Provider Name (Legal Business Name): BEONKA MARQUITA ROCHELLE WEEMS-HINES BA, QMHP, CMHP, QIDP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2024
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3769 QUARTON RD
BLOOMFIELD HILLS MI
48302-4058
US

IV. Provider business mailing address

3769 QUARTON RD
BLOOMFIELD HILLS MI
48302-4058
US

V. Phone/Fax

Practice location:
  • Phone: 248-894-1966
  • Fax:
Mailing address:
  • Phone: 248-894-1966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: