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General NPI Number Information
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NPI Number | 1457587149
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Entity Type | Organization
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Legal Business Name | WHOLENESS OF LIFE SERVICES
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Dates
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Enumeration Date | 06/08/2009
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Last Update Date | 06/08/2009
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Provider Practice Location Address
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Address Line | 26847 GRAND RIVER AVE
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City | REDFORD
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State | MI
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Zip | 48240-1544
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Country | US
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Telephone | 313-399-4915
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Fax |
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Provider Business Mailing Address
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Address Line | 23300 PROVIDENCE DR APT 401
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City | SOUTHFIELD
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State | MI
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Zip | 48075-3626
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Country | US
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Telephone | 313-399-4915
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. ANGELITA W HALL
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Credential | LMSW
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Telephone | 313-399-4915
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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 | 6801087570
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License Number State | MI
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