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General NPI Number Information
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NPI Number | 1184395410
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Entity Type | Organization
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Legal Business Name | HOLISTIC PSYCHIATRY
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Dates
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Enumeration Date | 09/27/2021
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 4050 E 12 MILE RD
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City | WARREN
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State | MI
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Zip | 48092-2534
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Country | US
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Telephone | 313-574-8579
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Fax |
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Provider Business Mailing Address
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Address Line | 680 BEDFORD LN
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City | GROSSE POINTE PARK
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State | MI
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Zip | 48230-1801
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Country | US
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Telephone | 313-574-8579
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BENS SANDAIRE
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Credential | DO
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Telephone | 586-582-0500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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