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General NPI Number Information
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NPI Number | 1306376439
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Entity Type | Organization
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Legal Business Name | ILLUMINATE COUNSELING & WELLNESS LLC
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Dates
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Enumeration Date | 06/12/2017
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Last Update Date | 06/12/2017
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Provider Practice Location Address
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Address Line | 42 STATE RD STE A
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City | NEWAYGO
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State | MI
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Zip | 49337-7989
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Country | US
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Telephone | 231-942-4673
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Fax |
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Provider Business Mailing Address
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Address Line | 42 STATE RD STE A
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City | NEWAYGO
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State | MI
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Zip | 49337-7989
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Country | US
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Telephone | 231-942-4673
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | JENNIFER BRAMAN
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Credential | LLMSW
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Telephone | 231-942-4673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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