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General NPI Number Information
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NPI Number | 1790330140
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Entity Type | Organization
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Legal Business Name | CHRISTIAN WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 08/02/2019
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Last Update Date | 08/02/2019
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Provider Practice Location Address
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Address Line | 2442 E MAPLE AVE STE 205
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City | FLINT
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State | MI
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Zip | 48507-4491
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Country | US
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Telephone | 810-771-8948
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 561
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City | FLINT
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State | MI
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Zip | 48501-0561
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Country | US
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Telephone | 810-771-8948
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EBONY C DUNIGAN
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Credential | LMFT
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Telephone | 810-771-8948
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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