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General NPI Number Information
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NPI Number | 1952927923
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Entity Type | Organization
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Legal Business Name | KINTSUGI WELLNESS COUNSELING INC
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Dates
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Enumeration Date | 06/24/2020
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Last Update Date | 01/19/2026
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Provider Practice Location Address
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Address Line | 1106 N CEDAR ST STE 200B
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City | LANSING
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State | MI
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Zip | 48906-5334
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Country | US
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Telephone | 517-819-2527
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Fax | 517-252-9409
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Provider Business Mailing Address
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Address Line | 2843 E GRAND RIVER AVE STE 239
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City | EAST LANSING
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State | MI
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Zip | 48823-6741
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Country | US
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Telephone | 517-819-2527
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Fax | 517-252-9409
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Authorized Official
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Title or Position | CEO
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Name | CAROL LYNN DIXON
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Credential | LMSW
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Telephone | 517-819-2527
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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 |
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License Number State |
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