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General NPI Number Information
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NPI Number | 1205441722
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Entity Type | Organization
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Legal Business Name | FAITH AND RADICAL SELF-LOVE, LLC
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Dates
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Enumeration Date | 09/11/2020
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Last Update Date | 02/04/2022
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Provider Practice Location Address
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Address Line | 22804 SHARROW AVE
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City | WARREN
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State | MI
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Zip | 48089-2882
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Country | US
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Telephone | 313-854-5102
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Fax | 313-251-7344
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Provider Business Mailing Address
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Address Line | 22804 SHARROW AVE
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City | WARREN
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State | MI
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Zip | 48089-2882
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Country | US
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Telephone | 313-854-5102
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Fax | 313-251-7344
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Authorized Official
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Title or Position | THERAPIST/OWNER
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Name | ZENOBIA KINDLE-DAVIS
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Credential |
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Telephone | 313-854-5102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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