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General NPI Number Information
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NPI Number | 1821988361
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Entity Type | Organization
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Legal Business Name | THE RECOVERY LAB PLLC
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Dates
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Enumeration Date | 07/07/2025
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 16250 NORTHLAND DR STE 239
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City | SOUTHFIELD
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State | MI
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Zip | 48075-5206
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Country | US
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Telephone | 313-800-2497
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Fax |
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Provider Business Mailing Address
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Address Line | 16250 NORTHLAND DR STE 239
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City | SOUTHFIELD
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State | MI
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Zip | 48075-5206
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Country | US
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Telephone | 313-800-2497
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. THIERA DANYAL CLIFFORD
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Credential | LP, LPC
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Telephone | 313-800-2497
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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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