Healthcare Provider Details

I. General information

NPI: 1750902912
Provider Name (Legal Business Name): JULIA MCGOWEN-BIENKOWSKI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35047 WILLIS ST
CLINTON TOWNSHIP MI
48035-2886
US

IV. Provider business mailing address

35047 WILLIS ST
CLINTON TOWNSHIP MI
48035-2886
US

V. Phone/Fax

Practice location:
  • Phone: 248-343-4618
  • Fax:
Mailing address:
  • Phone: 248-343-4618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JULIA MCGOWEN-BIENKOWSKI
Title or Position: OWNER
Credential: LPC
Phone: 248-343-4618