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General NPI Number Information
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NPI Number | 1053297630
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Entity Type | Organization
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Legal Business Name | REWIRE YOUR MIND BEHAVIORAL HEALTH COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 08/11/2025
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 110 S 3RD ST STE 120
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City | SAINT CLAIR
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State | MI
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Zip | 48079-5369
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Country | US
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Telephone | 810-858-8818
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Fax | 810-858-8818
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Provider Business Mailing Address
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Address Line | 110 S 3RD ST STE 120
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City | SAINT CLAIR
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State | MI
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Zip | 48079-5369
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Country | US
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Telephone | 810-858-8818
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Fax | 810-858-8818
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. GABRIELA MARITA VEGA
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Credential | LMSW-C
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Telephone | 810-858-8818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health 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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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