Healthcare Provider Details

I. General information

NPI: 1891492443
Provider Name (Legal Business Name): MINDING MIND BIZNEZZ, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2023
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42807 FORD RD STE 121
CANTON MI
48187-3357
US

IV. Provider business mailing address

43157 WASHINGTON WAY
CANTON MI
48187-3057
US

V. Phone/Fax

Practice location:
  • Phone: 313-574-5542
  • Fax:
Mailing address:
  • Phone: 313-574-5542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. DISHEKA DENISE BEVERLY-DANIELS
Title or Position: OWNER
Credential: LMSW-C
Phone: 313-574-5542