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General NPI Number Information
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NPI Number | 1700305059
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Entity Type | Organization
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Legal Business Name | MIND & BODY COUNSELING & COACHING PLLC
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Dates
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Enumeration Date | 09/18/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 407 E GRAND RIVER AVE STE C
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City | BRIGHTON
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State | MI
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Zip | 48116-1547
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Country | US
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Telephone | 810-623-7375
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Fax |
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Provider Business Mailing Address
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Address Line | 407 E GRAND RIVER AVE STE C
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City | BRIGHTON
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State | MI
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Zip | 48116-1547
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Country | US
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Telephone | 810-623-7375
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Fax |
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Authorized Official
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Title or Position | OWNER/ COUNSELOR
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Name | MRS. DAWN MARIE GADEN
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Credential | MA, LPC
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Telephone | 810-623-7375
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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 | 6401008212
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License Number State | MI
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