| Fountain Of Wisdom And Hope Llc | |
|
4710 W Saginaw Hwy Ste 9 Lansing MI 48917-2654 | |
| (517) 615-8312 | |
| Not Available |
| Full Name | Fountain Of Wisdom And Hope Llc |
|---|---|
| Speciality | Counselor |
| Location | 4710 W Saginaw Hwy Ste 9, Lansing, Michigan |
| Authorized Official Name and Position | Antoinette Mallett (CEO) |
| Authorized Official Contact | 5176840577 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fountain Of Wisdom And Hope Llc Po Box 10 Mason MI 48854-0010 Ph: () - | Fountain Of Wisdom And Hope Llc 4710 W Saginaw Hwy Ste 9 Lansing MI 48917-2654 Ph: (517) 615-8312 |
| NPI Number | 1427619758 |
|---|---|
| Provider Enumeration Date | 06/26/2019 |
| Last Update Date | 08/17/2023 |
| Certification Date | 08/17/2023 |
| Medicare PECOS PAC ID | 7315351913 |
|---|---|
| Medicare Enrollment ID | O20210121002692 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427619758 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
| Provider Name | Darlene Marie Davis |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1649576612 PECOS PAC ID: 4880023944 Enrollment ID: I20200411000772 |
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