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General NPI Number Information
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NPI Number | 1417315466
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Entity Type | Organization
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Legal Business Name | TEAM WELLNESS
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Dates
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Enumeration Date | 02/05/2016
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Last Update Date | 02/05/2016
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Provider Practice Location Address
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Address Line | 14799 DIX-TOLEDO RD
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City | SOUTHGATE
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State | MI
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Zip | 48915
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Country | US
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Telephone | 734-324-8326
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Fax | 734-324-8327
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Provider Business Mailing Address
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Address Line | 921 HOWARD ST
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City | DEARBORN
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State | MI
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Zip | 48124
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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 | HUMAN RESOURCE DIRECTOR
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Name | AMALIA SOUTH
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Credential |
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Telephone | 313-274-3700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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