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General NPI Number Information
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NPI Number | 1356087530
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Entity Type | Organization
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Legal Business Name | SUPERIOR POTENTIAL P.L.L.C.
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Dates
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Enumeration Date | 05/10/2022
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Last Update Date | 05/10/2022
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Provider Practice Location Address
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Address Line | 7602 STATE HIGHWAY M123
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City | NEWBERRY
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State | MI
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Zip | 49868-8128
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Country | US
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Telephone | 906-322-9576
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Fax | 906-293-7150
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Provider Business Mailing Address
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Address Line | 7602 STATE HIGHWAY M123
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City | NEWBERRY
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State | MI
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Zip | 49868-8128
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Country | US
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Telephone | 906-322-9576
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Fax | 906-293-7150
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Authorized Official
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Title or Position | OWNER/CLINICAL SOCIAL WORKER
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Name | LAURA LYNN GENEROU
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Credential | LCSW
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Telephone | 906-322-9576
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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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