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General NPI Number Information
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NPI Number | 1578118980
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Entity Type | Organization
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Legal Business Name | BRIGHT WHITE WAVE HEALING CENTER
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Dates
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Enumeration Date | 08/04/2019
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Last Update Date | 08/04/2019
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Provider Practice Location Address
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Address Line | 96 LYNDON CIR
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City | OAKLAND
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State | MI
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Zip | 48363-1322
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Country | US
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Telephone | 248-766-2036
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Fax |
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Provider Business Mailing Address
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Address Line | 96 LYNDON CIR
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City | OAKLAND
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State | MI
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Zip | 48363-1322
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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 | DIRECTOR
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Name | GENEVIEVE TAYLOR
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Credential | LPC
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Telephone | 248-766-2036
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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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