Healthcare Provider Details

I. General information

NPI: 1649854993
Provider Name (Legal Business Name): PROMISE JOY MOTLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PROMISE JOY WINCHESTER

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 COVINGTON CT UNIT 201
LANSING MI
48912-4940
US

IV. Provider business mailing address

8834 BERGENIA CT
REYNOLDSBURG OH
43068-6777
US

V. Phone/Fax

Practice location:
  • Phone: 614-371-3208
  • Fax:
Mailing address:
  • Phone: 614-371-3208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451019316
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: