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General NPI Number Information
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NPI Number | 1689826307
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Entity Type | Organization
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Legal Business Name | RADIANT HEALTH RESOURCES
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Dates
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Enumeration Date | 10/13/2008
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Last Update Date | 10/13/2008
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Provider Practice Location Address
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Address Line | 18090 MACK AVE
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City | GROSSE POINTE
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State | MI
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Zip | 48230-6251
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Country | US
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Telephone | 586-202-0474
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Fax |
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Provider Business Mailing Address
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Address Line | 18090 MACK AVE
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City | GROSSE POINTE
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State | MI
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Zip | 48230-6251
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Country | US
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Telephone | 586-202-0474
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAPHNE DEMARIS
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Credential | MA, LPC
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Telephone | 586-202-0474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6401007055
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License Number State | MI
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