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General NPI Number Information
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NPI Number | 1649092248
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Entity Type | Organization
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Legal Business Name | WISE PATH PSYCHOTHERAPY, LLC
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Dates
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Enumeration Date | 10/25/2024
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 9689 CARPENTER RD
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City | MILAN
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State | MI
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Zip | 48160-9547
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Country | US
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Telephone | 734-735-9695
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Fax |
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Provider Business Mailing Address
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Address Line | 455 E EISENHOWER PKWY STE 300
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City | ANN ARBOR
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State | MI
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Zip | 48108-3324
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Country | US
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Telephone | 734-735-9695
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | ALEXANDRA RUTH WILT
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Credential | LMSW
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Telephone | 734-735-9695
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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 |
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License Number State |
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