Healthcare Provider Details

I. General information

NPI: 1285978643
Provider Name (Legal Business Name): HEGIRA WESTLAND COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2012
Last Update Date: 11/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8623 N WAYNE RD SUITE 310
WESTLAND MI
48185-1137
US

IV. Provider business mailing address

8623 N WAYNE RD SUITE 310
WESTLAND MI
48185-1137
US

V. Phone/Fax

Practice location:
  • Phone: 734-425-0636
  • Fax:
Mailing address:
  • Phone: 734-425-0636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number6301011507
License Number StateMI

VIII. Authorized Official

Name: MS. JENNIFER BURGER
Title or Position: CLINICAL SERVICES SUPERVISOR
Credential:
Phone: 734-425-0636