| Ignite 3 Llc | |
|
28491 Utica Rd Roseville MI 48066-2593 | |
| (352) 552-5686 | |
| Not Available |
| Full Name | Ignite 3 Llc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 28491 Utica Rd, Roseville, Michigan |
| Authorized Official Name and Position | Lisa Brooks (OWNER) |
| Authorized Official Contact | 3525525686 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ignite 3 Llc 28491 Utica Rd Roseville MI 48066-2593 Ph: (352) 552-5686 | Ignite 3 Llc 28491 Utica Rd Roseville MI 48066-2593 Ph: (352) 552-5686 |
| NPI Number | 1891360269 |
|---|---|
| Provider Enumeration Date | 05/26/2021 |
| Last Update Date | 05/26/2021 |
| Certification Date | 05/26/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891360269 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
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