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General NPI Number Information
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NPI Number | 1285284794
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Entity Type | Organization
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Legal Business Name | DETROIT HEALTH & WELLNESS, PLLC
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Dates
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Enumeration Date | 09/17/2019
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Last Update Date | 09/17/2019
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Provider Practice Location Address
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Address Line | 1001 WOODWARD AVE FL 5
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City | DETROIT
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State | MI
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Zip | 48226-1904
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Country | US
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Telephone | 313-739-7836
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Fax | 313-557-1662
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Provider Business Mailing Address
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Address Line | 8200 E JEFFERSON AVE APT 1604
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City | DETROIT
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State | MI
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Zip | 48214-3978
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Country | US
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Telephone | 248-766-3209
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. SANDRA KRISTINE JOHNSON
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Credential | PH.D.
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Telephone | 248-766-3209
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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