Healthcare Provider Details

I. General information

NPI: 1982105995
Provider Name (Legal Business Name): INNER DAWN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2018
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 S MAIN ST STE 2
ONSTED MI
49265-9682
US

IV. Provider business mailing address

PO BOX 10
MASON MI
48854-0010
US

V. Phone/Fax

Practice location:
  • Phone: 517-292-3305
  • Fax:
Mailing address:
  • Phone: 517-676-9788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: NICHOLE BELLFY
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: CSW
Phone: 517-292-3305