Healthcare Provider Details

I. General information

NPI: 1356123285
Provider Name (Legal Business Name): YOVA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20131 JAMES COUZENS FWY
DETROIT MI
48235-1890
US

IV. Provider business mailing address

20131 JAMES COUZENS FWY
DETROIT MI
48235-1890
US

V. Phone/Fax

Practice location:
  • Phone: 313-850-9837
  • Fax:
Mailing address:
  • Phone: 313-445-4765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. KISHVA DANIEL
Title or Position: ADMINISTRATOR
Credential:
Phone: 313-850-9837