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General NPI Number Information
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NPI Number | 1073254389
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Entity Type | Organization
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Legal Business Name | REIMAGINE TELEHEALTH COUNSELING AND CONSULTING SERVICES
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Dates
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Enumeration Date | 04/02/2022
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Last Update Date | 04/02/2022
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Provider Practice Location Address
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Address Line | 2500 S LINDEN RD
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City | FLINT
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State | MI
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Zip | 48532-7074
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Country | US
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Telephone | 810-655-3867
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Fax |
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Provider Business Mailing Address
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Address Line | 2500 S. LINDEN RD P.O.BOX 320115
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City | FLINT
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State | MI
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Zip | 48532-9998
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Country | US
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Telephone | 810-655-3867
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KOASTER UVETTE BRIM
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Credential | MSW, LMSW
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Telephone | 810-655-3867
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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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