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General NPI Number Information
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NPI Number | 1588259881
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Entity Type | Organization
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Legal Business Name | GROWING WELL CLINICAL THERAPY LLC
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Dates
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Enumeration Date | 03/08/2021
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 7800 W OUTER DR STE LL04
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City | DETROIT
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State | MI
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Zip | 48235-3461
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Country | US
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Telephone | 734-846-5723
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Fax | 734-331-3630
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Provider Business Mailing Address
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Address Line | PO BOX 734
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City | INKSTER
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State | MI
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Zip | 48141-0734
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Country | US
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Telephone | 734-846-5723
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Fax | 734-331-3630
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Authorized Official
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Title or Position | CLINICAL DIRECTOR/ OWNER
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Name | MAQUIRA OLIVER
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Credential | LMSW
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Telephone | 313-899-8408
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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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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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