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General NPI Number Information
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NPI Number | 1821839960
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Entity Type | Organization
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Legal Business Name | TOTAL MIND AND BODY LLC
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Dates
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Enumeration Date | 06/03/2024
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 1233 ABBEY CT
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City | WESTLAND
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State | MI
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Zip | 48185-8521
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Country | US
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Telephone | 734-502-2367
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Fax |
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Provider Business Mailing Address
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Address Line | 1233 ABBEY CT
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City | WESTLAND
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State | MI
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Zip | 48185-8521
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Country | US
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Telephone | 734-502-2367
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | MR. TERRY EDWARDS JR.
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Credential |
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Telephone | 734-502-2367
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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