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General NPI Number Information
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NPI Number | 1851749873
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Entity Type | Organization
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Legal Business Name | INNOVATIVE HOPE THERAPY
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Dates
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Enumeration Date | 05/31/2016
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Last Update Date | 05/31/2016
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Provider Practice Location Address
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Address Line | 3366 HESSEL AVE
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-4842
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Country | US
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Telephone | 248-895-4258
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Fax |
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Provider Business Mailing Address
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Address Line | 3366 HESSEL AVE
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-4842
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANDREA BUNKER
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Credential |
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Telephone | 248-895-4258
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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 | 6801092421
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License Number State | MI
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