| Life Water Support Services Llc | |
|
23999 W 10 Mile Rd # 220 Southfield MI 48033-3158 | |
| (248) 327-6593 | |
| (248) 996-8903 |
| Full Name | Life Water Support Services Llc |
|---|---|
| Speciality | Counselor |
| Location | 23999 W 10 Mile Rd # 220, Southfield, Michigan |
| Authorized Official Name and Position | Kim Latease Bishopjohnson (DIRECTOR) |
| Authorized Official Contact | 7344448512 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Water Support Services Llc 23999 W 10 Mile Rd # 220 Southfield MI 48033-3158 Ph: (248) 327-6593 | Life Water Support Services Llc 23999 W 10 Mile Rd # 220 Southfield MI 48033-3158 Ph: (248) 327-6593 |
| NPI Number | 1598134983 |
|---|---|
| Provider Enumeration Date | 09/16/2015 |
| Last Update Date | 01/12/2022 |
| Certification Date | 01/12/2022 |
| Medicare PECOS PAC ID | 2567869100 |
|---|---|
| Medicare Enrollment ID | O20210923001945 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598134983 | NPI | - | NPPES |
| Provider Name | Jacqueline M Dunn-bell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558427104 PECOS PAC ID: 2466429394 Enrollment ID: I20040910001203 |
| Provider Name | Florine Bond |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770505075 PECOS PAC ID: 8123021177 Enrollment ID: I20060814000244 |
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