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General NPI Number Information
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NPI Number | 1023757770
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Entity Type | Organization
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Legal Business Name | BEHIND THE LINE, LC
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Dates
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Enumeration Date | 06/01/2022
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Last Update Date | 06/01/2022
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Provider Practice Location Address
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Address Line | 29915 WEST RD
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City | NEW BOSTON
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State | MI
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Zip | 48164-9473
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Country | US
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Telephone | 734-642-7365
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Fax |
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Provider Business Mailing Address
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Address Line | 26216 GIBRALTAR RD UNIT 1072
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City | FLAT ROCK
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State | MI
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Zip | 48134-7738
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JESSICA BALOWSKI
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Credential | LMSW
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Telephone | 734-642-7365
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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