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General NPI Number Information
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NPI Number | 1154894376
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Entity Type | Organization
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Legal Business Name | REGIONAL PSYCHOLOGY AND WELLNESS, LLC
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Dates
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Enumeration Date | 01/10/2019
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Last Update Date | 01/10/2019
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Provider Practice Location Address
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Address Line | 4845 SNYDER AVE
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City | FREMONT
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State | MI
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Zip | 49412-8573
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Country | US
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Telephone | 231-924-6920
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Fax |
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Provider Business Mailing Address
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Address Line | 4845 SNYDER AVE
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City | FREMONT
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State | MI
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Zip | 49412-8573
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Country | US
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Telephone | 231-924-6920
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Fax | 231-924-9170
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | SHANOA DIONE PRAAY
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Credential | LLP
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Telephone | 616-994-3389
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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