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General NPI Number Information
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NPI Number | 1659659647
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Entity Type | Organization
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Legal Business Name | MIND AND BODY HOLISTIC HEALTH
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Dates
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Enumeration Date | 07/26/2011
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Last Update Date | 07/26/2011
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Provider Practice Location Address
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Address Line | 29 MASSACHUSETTS ST
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City | HIGHLAND PARK
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State | MI
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Zip | 48203-3536
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Country | US
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Telephone | 313-422-3109
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Fax |
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Provider Business Mailing Address
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Address Line | 440 BURROUGHS ST
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City | DETROIT
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State | MI
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Zip | 48202-3429
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Country | US
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Telephone | 313-422-3109
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | SHARIFA HARVEY
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Credential | LMSW
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Telephone | 313-422-3109
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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 | 6801085560
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License Number State | MI
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