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General NPI Number Information
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NPI Number | 1841880192
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Entity Type | Organization
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Legal Business Name | TRUBLU THERAPY, PLLC
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Dates
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Enumeration Date | 01/21/2021
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Last Update Date | 08/05/2021
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Provider Practice Location Address
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Address Line | 8040 ORTONVILLE RD STE C
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City | CLARKSTON
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State | MI
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Zip | 48348-4468
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Country | US
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Telephone | 980-319-8722
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Fax |
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Provider Business Mailing Address
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Address Line | 531 BRENTWOOD RD SUITE 153
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City | DENVER
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State | NC
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Zip | 28037-0269
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Country | US
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Telephone | 704-310-1480
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Fax | 704-966-0135
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Authorized Official
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Title or Position | OWNER
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Name | MICHELLE UGOLINI
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Credential | LCSW
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Telephone | 714-310-1480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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