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General NPI Number Information
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NPI Number | 1417772831
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Entity Type | Organization
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Legal Business Name | YOUNG LIFE WELLNESS
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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 | 191 13 COLONIES LN
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City | FLINT
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State | MI
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Zip | 48507-5908
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Country | US
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Telephone | 810-428-7477
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Fax |
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Provider Business Mailing Address
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Address Line | 2500 S LINDEN RD UNIT 320126
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City | FLINT
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State | MI
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Zip | 48532-7007
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Country | US
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Telephone | 248-702-4463
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KRISTIN M BLEVINS
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Credential | LMSW, CAADC, CCS
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Telephone | 810-428-7477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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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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