Healthcare Provider Details

I. General information

NPI: 1245897503
Provider Name (Legal Business Name): HEALTHY CHOICE COMMUNITY CENTERED COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19300 GREENFIELD RD STE B
DETROIT MI
48235-2003
US

IV. Provider business mailing address

19300 GREENFIELD RD STE B
DETROIT MI
48235-2003
US

V. Phone/Fax

Practice location:
  • Phone: 313-468-2842
  • Fax:
Mailing address:
  • Phone: 313-468-2842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MISS KIMBERLY WALTON
Title or Position: OWNER
Credential:
Phone: 313-468-2842