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General NPI Number Information
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NPI Number | 1528946746
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Entity Type | Organization
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Legal Business Name | LIFE WATER COUNSELING & SUPPORT PLLC
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Dates
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Enumeration Date | 08/25/2025
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 23800 W 10 MILE RD STE 150
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City | SOUTHFIELD
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State | MI
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Zip | 48033-3123
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Country | US
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Telephone | 248-327-6593
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Fax |
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Provider Business Mailing Address
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Address Line | 23800 W 10 MILE RD STE 150
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City | SOUTHFIELD
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State | MI
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Zip | 48033-3123
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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 | CEO
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Name | KIM LATEASE BISHOP-JOHNSON
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Credential |
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Telephone | 248-945-2700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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