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General NPI Number Information
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NPI Number | 1891492443
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Entity Type | Organization
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Legal Business Name | MINDING MIND BIZNEZZ, LLC
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Dates
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Enumeration Date | 02/14/2023
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Last Update Date | 11/10/2023
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Provider Practice Location Address
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Address Line | 42807 FORD RD STE 121
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City | CANTON
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State | MI
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Zip | 48187-3357
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Country | US
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Telephone | 313-574-5542
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Fax |
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Provider Business Mailing Address
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Address Line | 43157 WASHINGTON WAY
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City | CANTON
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State | MI
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Zip | 48187-3057
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Country | US
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Telephone | 313-574-5542
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. DISHEKA DENISE BEVERLY-DANIELS
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Credential | LMSW-C
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Telephone | 313-574-5542
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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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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