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NPI 1306497318

NPI 1306497318 : DETROIT HEALTH AND WELLNESS, PLLC : DETROIT, MI

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General NPI Number Information
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    NPI Number           |    1306497318
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    Entity Type          |    Organization 
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    Legal Business Name  |    DETROIT HEALTH AND WELLNESS, PLLC 
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Dates
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    Enumeration Date     |    09/23/2019
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    Last Update Date     |    12/02/2025
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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 1910 
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    City                 |    DETROIT
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    State                |    MI
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    Zip                  |    48214-3932
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    Country              |    US
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    Telephone            |    248-766-3209
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    Fax                  |    313-557-1662
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Authorized Official
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    Title or Position    |    OWNER
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    Name                 |     SANDRA K JOHNSON-GAMLIN 
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    Credential           |    PHD
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    Telephone            |    313-739-7836
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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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