Provider Demographics
NPI:1386358885
Name:DIFFERENT APPROACH WELLNESS CENTER
Entity type:Organization
Organization Name:DIFFERENT APPROACH WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THERA
Authorized Official - Middle Name:TERRES
Authorized Official - Last Name:RADNEY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:313-536-3040
Mailing Address - Street 1:20905 GREENFIELD RD STE 701M
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-5356
Mailing Address - Country:US
Mailing Address - Phone:313-536-3040
Mailing Address - Fax:313-536-3041
Practice Address - Street 1:20905 GREENFIELD RD STE 701M
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5356
Practice Address - Country:US
Practice Address - Phone:313-536-3040
Practice Address - Fax:313-536-3041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty