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General NPI Number Information
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NPI Number | 1932784766
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Entity Type | Organization
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Legal Business Name | SERENITY DEN
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Dates
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Enumeration Date | 03/12/2021
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Last Update Date | 03/12/2021
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Provider Practice Location Address
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Address Line | 24567 NORTHWESTERN HWY STE 302A
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City | SOUTHFIELD
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State | MI
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Zip | 48075-2412
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Country | US
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Telephone | 248-897-6431
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Fax |
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Provider Business Mailing Address
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Address Line | 33045 PARKHILL ST APT 202
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City | WAYNE
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State | MI
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Zip | 48184-1339
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Country | US
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Telephone | 248-897-6431
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Fax |
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Authorized Official
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Title or Position | MASSAGE THERAPIST
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Name | KHIA ADESINA
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Credential | LMT
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Telephone | 248-897-6431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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