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General NPI Number Information
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NPI Number | 1740531185
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Entity Type | Organization
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Legal Business Name | WIGS 4 KIDS
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Dates
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Enumeration Date | 09/25/2012
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Last Update Date | 09/25/2012
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Provider Practice Location Address
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Address Line | 31235 HARPER AVE
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48082-1425
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Country | US
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Telephone | 586-772-6656
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Fax | 586-772-6674
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Provider Business Mailing Address
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Address Line | 30126 HARPER AVE
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48082-1648
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Country | US
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Telephone | 586-772-6656
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Fax | 586-772-6674
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Authorized Official
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Title or Position | CEO
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Name | MAGGIE VARNEY
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Credential |
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Telephone | 586-772-6656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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