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General NPI Number Information
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NPI Number | 1720521958
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Entity Type | Organization
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Legal Business Name | JOURNEY WITHIN LLC
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Dates
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Enumeration Date | 11/20/2016
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Last Update Date | 11/20/2016
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Provider Practice Location Address
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Address Line | 29623 NORTHWESTERN HWY
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1076
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Country | US
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Telephone | 248-225-8240
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Fax |
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Provider Business Mailing Address
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Address Line | 26342 DUNDALK ST
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-4812
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Country | US
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Telephone | 248-225-8240
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | MRS. LORI ELLEN GORDON-MICHAELI
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Credential | LMSW
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Telephone | 248-225-8240
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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 | 6801095173
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License Number State | MI
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