Provider Demographics
NPI:1871739417
Name:INNER WISDOM COUNSELING
Entity type:Organization
Organization Name:INNER WISDOM COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-348-1270
Mailing Address - Street 1:224 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1645
Mailing Address - Country:US
Mailing Address - Phone:248-348-1270
Mailing Address - Fax:248-347-3393
Practice Address - Street 1:224 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1645
Practice Address - Country:US
Practice Address - Phone:248-348-1270
Practice Address - Fax:248-347-3393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-04
Last Update Date:2009-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005242251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1649210931OtherINDIVDUAL NPI
MI1649210931OtherINDIVDUAL NPI