Healthcare Provider Details

I. General information

NPI: 1962022525
Provider Name (Legal Business Name): REAL LIFE CONVERSATIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 FLUSHING ROAD SUITE 262A
FLINT MI
48504
US

IV. Provider business mailing address

6078 FOUNTAIN POINTE APT 3
GRAND BLANC MI
48439-7625
US

V. Phone/Fax

Practice location:
  • Phone: 810-597-6564
  • Fax:
Mailing address:
  • Phone: 810-597-6564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMESHIA JOHNSON
Title or Position: OWNER
Credential: LMSW
Phone: 810-597-6564