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General NPI Number Information
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NPI Number | 1336655182
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Entity Type | Organization
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Legal Business Name | TRANSFORMATIVE MIND COUNSELING LLC
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Dates
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Enumeration Date | 12/15/2017
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Last Update Date | 08/20/2018
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Provider Practice Location Address
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Address Line | 17368 W 12 MILE RD STE 201
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City | SOUTHFIELD
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State | MI
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Zip | 48076
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Country | US
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Telephone | 313-492-8452
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Fax | 248-856-3801
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Provider Business Mailing Address
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Address Line | 18180 MEADOWOOD AVE
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City | LATHRUP VILLAGE
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State | MI
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Zip | 48076-4514
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Country | US
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Telephone | 313-492-8452
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | AJA BURKS
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Credential | LMSW
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Telephone | 313-492-8452
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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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