Healthcare Provider Details

I. General information

NPI: 1023889904
Provider Name (Legal Business Name): HEARTFUL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2024
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 W 9 MILE RD
FERNDALE MI
48220-2914
US

IV. Provider business mailing address

1629 VIRGINIA PARK ST
DETROIT MI
48206-2419
US

V. Phone/Fax

Practice location:
  • Phone: 313-889-3432
  • Fax:
Mailing address:
  • Phone: 347-210-5373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: STEVEN JOHN WARE
Title or Position: OWNER
Credential: LMSW
Phone: 347-210-5373