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General NPI Number Information
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NPI Number | 1396495750
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Entity Type | Organization
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Legal Business Name | INKWELL THERAPY AND CONSULTING LLC
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Dates
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Enumeration Date | 03/28/2022
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Last Update Date | 03/28/2022
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Provider Practice Location Address
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Address Line | 51382 GRATIOT AVE # 1003
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City | CHESTERFIELD
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State | MI
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Zip | 48051-2035
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Country | US
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Telephone | 586-322-4927
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Fax |
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Provider Business Mailing Address
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Address Line | 51382 GRATIOT AVE # 1003
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City | CHESTERFIELD
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State | MI
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Zip | 48051-2035
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Country | US
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Telephone | 586-322-4927
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Fax |
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Authorized Official
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Title or Position | OWNER/LMSW
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Name | TIERRA EMERSON
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Credential | LMSW
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Telephone | 586-322-4927
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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