Healthcare Provider Details

I. General information

NPI: 1114523156
Provider Name (Legal Business Name): UPLIFT & INSPIRE,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2020
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6035 EXECUTIVE DR STE 204
LANSING MI
48911-5338
US

IV. Provider business mailing address

6035 EXECUTIVE DR STE 204
LANSING MI
48911-5338
US

V. Phone/Fax

Practice location:
  • Phone: 734-627-7669
  • Fax: 734-627-6001
Mailing address:
  • Phone: 734-627-7669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. DOMONIKA TIPTON
Title or Position: THERAPIST
Credential: LMSW
Phone: 734-627-7669