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General NPI Number Information
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NPI Number | 1003289166
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Entity Type | Organization
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Legal Business Name | WHOLE BODY HEALTH AND WELLNESS CENTER INC
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Dates
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Enumeration Date | 11/10/2015
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 17250 W 12 MILE RD
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City | SOUTHFIELD
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State | MI
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Zip | 48076-2127
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Country | US
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Telephone | 248-632-6737
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Fax |
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Provider Business Mailing Address
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Address Line | 22341 W 8 MILE RD
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City | DETROIT
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State | MI
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Zip | 48219-1217
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Country | US
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Telephone | 248-632-6737
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MS. VARONICA FREEMAN
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Credential |
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Telephone | 513-260-9643
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | SA0823273
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number | SA0823273
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | SA0823273
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6801011245
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License Number State | MI
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