Healthcare Provider Details

I. General information

NPI: 1891606976
Provider Name (Legal Business Name): THE HEALING BOWL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9209 MINOCK ST
DETROIT MI
48228-1759
US

IV. Provider business mailing address

9209 MINOCK ST
DETROIT MI
48228-1759
US

V. Phone/Fax

Practice location:
  • Phone: 248-513-0722
  • Fax:
Mailing address:
  • Phone: 248-513-0722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name: CRYSTLE WHITE
Title or Position: ADMINISTRATOR
Credential:
Phone: 248-513-0722