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General NPI Number Information
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NPI Number | 1952817389
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Entity Type | Organization
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Legal Business Name | WITH MOM IN MIND,LLC
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Dates
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Enumeration Date | 12/21/2017
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Last Update Date | 12/21/2017
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Provider Practice Location Address
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Address Line | 18501 WEST MILE ROAD
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City | SOUTHFIELD
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State | MI
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Zip | 48075
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Country | US
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Telephone | 313-492-8446
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Fax | 248-200-7968
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Provider Business Mailing Address
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Address Line | 18501 WEST MILE ROAD
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City | SOUTHFIELD
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State | MI
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Zip | 48075
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Country | US
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Telephone | 313-492-8446
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Fax | 248-200-7968
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Authorized Official
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Title or Position | REGISTERED DIETETIC TECHNICIAN
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Name | STEPHANIE MARIE CARTER
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Credential | NDTR,CDM,CFPP, CPT
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Telephone | 313-492-8446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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Taxonomy #3
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Taxonomy Code | 251T00000X
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Taxonomy Name | PACE Provider Organization
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QA0005X
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Taxonomy Name | Ambulatory Family Planning Facility
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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Taxonomy #6
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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Taxonomy #7
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Taxonomy Code | 261QP0905X
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Taxonomy Name | State or Local Public Health Clinic/Center
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License Number |
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Taxonomy #8
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 261QP0904X
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Taxonomy Name | Federal Public Health Clinic/Center
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License Number |
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License Number State |
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