Provider Demographics
NPI:1285284794
Name:DETROIT HEALTH & WELLNESS, PLLC
Entity type:Organization
Organization Name:DETROIT HEALTH & WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:KRISTINE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-766-3209
Mailing Address - Street 1:8200 E JEFFERSON AVE APT 1604
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-3978
Mailing Address - Country:US
Mailing Address - Phone:248-766-3209
Mailing Address - Fax:
Practice Address - Street 1:1001 WOODWARD AVE FL 5
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-1904
Practice Address - Country:US
Practice Address - Phone:313-739-7836
Practice Address - Fax:313-557-1662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty