Supreme Life Wellness PLLC
Social Worker in Southfield, MI. Organization (NPI-2).
NPI number1245014232
StatusActive
Last updated in NPPESOct 12, 2023
Details
- NPI
- 1245014232
- Entity type
- Organization (NPI-2)
- Legal business name
- Supreme Life Wellness PLLC
- Organization subpart
- No
- Enumeration date
- Aug 22, 2023
- Certification date
- Oct 12, 2023
- Last updated
- Oct 12, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 104100000X | Social Worker | – | – | Yes |
Practice location
16970 New Hampshire DrSouthfield, MI 48075-2905
Phone 313-522-4708
Mailing address
16970 New Hampshire DrSouthfield, MI 48075-2905
Phone 313-522-4708
Authorized official
Samantha Trapp
Owner
3135224708
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