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General NPI Number Information
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NPI Number | 1871739417
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Entity Type | Organization
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Legal Business Name | INNER WISDOM COUNSELING
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Dates
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Enumeration Date | 01/04/2009
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Last Update Date | 01/04/2009
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Provider Practice Location Address
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Address Line | 224 S MAIN ST
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City | NORTHVILLE
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State | MI
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Zip | 48167-1645
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Country | US
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Telephone | 248-348-1270
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Fax | 248-347-3393
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Provider Business Mailing Address
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Address Line | 224 S MAIN ST
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City | NORTHVILLE
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State | MI
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Zip | 48167-1645
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Country | US
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Telephone | 248-348-1270
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Fax | 248-347-3393
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID MICHAEL CONNELL
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Credential | PHD
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Telephone | 248-348-1270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6301005242
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License Number State | MI
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