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General NPI Number Information
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NPI Number | 1386469781
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Entity Type | Organization
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Legal Business Name | SLICE LIFE MENTAL HEALTH AND PERFORMANCE COACHING
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Dates
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Enumeration Date | 11/20/2024
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 26648 KENNETH CT
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City | REDFORD
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State | MI
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Zip | 48239-1922
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Country | US
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Telephone | 215-651-9574
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Fax |
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Provider Business Mailing Address
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Address Line | 26648 KENNETH CT
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City | REDFORD
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State | MI
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Zip | 48239-1922
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/LEAD THERAPIST
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Name | HYDEEN K BEVERLY
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Credential | PHD, LMSW
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Telephone | 215-651-9574
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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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