Healthcare Provider Details

I. General information

NPI: 1972431674
Provider Name (Legal Business Name): HERITAGE HOLISTIC BEHAVIORAL HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29532 SOUTHFIELD RD STE 115
SOUTHFIELD MI
48076-2023
US

IV. Provider business mailing address

29532 SOUTHFIELD RD STE 115
SOUTHFIELD MI
48076-2023
US

V. Phone/Fax

Practice location:
  • Phone: 947-217-7198
  • Fax: 877-218-6118
Mailing address:
  • Phone: 947-217-7198
  • Fax: 877-218-6118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHNICE FAITH LITTLEJOHN
Title or Position: MANAGING MEMBER
Credential: DO MPH
Phone: 313-310-9246