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General NPI Number Information
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NPI Number | 1033759659
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Entity Type | Organization
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Legal Business Name | NEW LIFE ALTERNATIVES LLC
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Dates
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Enumeration Date | 01/11/2020
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 3281 COOLIDGE HWY
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City | BERKLEY
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State | MI
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Zip | 48072-1633
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Country | US
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Telephone | 313-915-9138
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Fax | 313-216-2776
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Provider Business Mailing Address
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Address Line | 24340 DANTE ST
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City | OAK PARK
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State | MI
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Zip | 48237-3610
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Country | US
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Telephone | 313-915-9138
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | SEVERIA ADOLPHUS
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Credential | PMHNP-BC
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Telephone | 313-915-9138
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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