Healthcare Provider Details

I. General information

NPI: 1093620569
Provider Name (Legal Business Name): THE SPACE BETWEEN COUNSELING AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 W CLARKSTON RD STE 500
LAKE ORION MI
48362-2898
US

IV. Provider business mailing address

169 W CLARKSTON RD STE 500
LAKE ORION MI
48362-2898
US

V. Phone/Fax

Practice location:
  • Phone: 248-431-8873
  • Fax:
Mailing address:
  • Phone: 248-431-8873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. LAUREN BORDES
Title or Position: OWNER
Credential: LMSW
Phone: 248-431-8873