| NPI | 1730683368 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAUREN LUCIELLE PROVENCHER Owner/Clinical Therapist 248-397-4705 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801093391) |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2018-05-05 |