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General NPI Number Information
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NPI Number | 1821690819
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Entity Type | Organization
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Legal Business Name | SUNFISH COUNSELING LLC
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Dates
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Enumeration Date | 11/13/2020
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Last Update Date | 11/13/2020
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Provider Practice Location Address
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Address Line | 535 GRISWOLD STREET SUITE 111 #306
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City | DETROIT
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State | MI
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Zip | 48226-4822
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Country | US
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Telephone | 734-648-6353
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Fax |
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Provider Business Mailing Address
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Address Line | 535 GRISWOLD STREET SUITE 111 #306
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City | DETROIT
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State | MI
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Zip | 48226
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Country | US
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Telephone | 734-648-6353
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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 | JAMIE HIBBS
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Credential | MS
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Telephone | 734-648-6353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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