Healthcare Provider Details

I. General information

NPI: 1376280818
Provider Name (Legal Business Name): IMANI YA KUPINGA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2022
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27760 FRANKLIN RD
SOUTHFIELD MI
48034-2300
US

IV. Provider business mailing address

27760 FRANKLIN RD
SOUTHFIELD MI
48034-2300
US

V. Phone/Fax

Practice location:
  • Phone: 734-678-2048
  • Fax:
Mailing address:
  • Phone: 734-678-2048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE D FLINT
Title or Position: OWNER
Credential: LMSW
Phone: 734-678-2048