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General NPI Number Information
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NPI Number | 1316500713
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Entity Type | Organization
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Legal Business Name | HEALING PATHWAYS CENTER FOR PSYCHOTHERAPY & MINDFULNESS, PLLC
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Dates
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Enumeration Date | 04/21/2019
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Last Update Date | 01/07/2021
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Provider Practice Location Address
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Address Line | 8123 GRAND RIVER RD STE D
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City | BRIGHTON
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State | MI
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Zip | 48114-9464
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Country | US
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Telephone | 734-646-2248
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Fax |
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Provider Business Mailing Address
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Address Line | 8123 GRAND RIVER RD STE 4
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City | BRIGHTON
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State | MI
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Zip | 48114-9464
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Country | US
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Telephone | 810-206-1077
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Fax | 810-821-0877
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Authorized Official
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Title or Position | OWNER/CLINICAN
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Name | JENNIFER DIANE MARSHALL
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Credential | LMSW
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Telephone | 810-206-1077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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