Healthcare Provider Details

I. General information

NPI: 1447640065
Provider Name (Legal Business Name): WINGS OF VIRTUE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23580 ORCHARD LAKE RD
FARMINGTON HILLS MI
48336-3241
US

IV. Provider business mailing address

PO BOX 25
SOUTHFIELD MI
48037-0025
US

V. Phone/Fax

Practice location:
  • Phone: 248-327-6099
  • Fax: 866-327-2570
Mailing address:
  • Phone: 248-327-6099
  • Fax: 866-327-2570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. TEZONIA MORGAN
Title or Position: CEO
Credential: PH.D
Phone: 248-327-6099