| Supreme Life Wellness Pllc | |
|
16970 New Hampshire Dr Southfield MI 48075-2905 | |
| (313) 522-4708 | |
| Not Available |
| Full Name | Supreme Life Wellness Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 16970 New Hampshire Dr, Southfield, Michigan |
| Authorized Official Name and Position | Samantha Trapp (OWNER) |
| Authorized Official Contact | 3135224708 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Supreme Life Wellness Pllc 16970 New Hampshire Dr Southfield MI 48075-2905 Ph: (313) 522-4708 | Supreme Life Wellness Pllc 16970 New Hampshire Dr Southfield MI 48075-2905 Ph: (313) 522-4708 |
| NPI Number | 1245014232 |
|---|---|
| Provider Enumeration Date | 08/22/2023 |
| Last Update Date | 10/12/2023 |
| Certification Date | 10/12/2023 |
| Medicare PECOS PAC ID | 4082064589 |
|---|---|
| Medicare Enrollment ID | O20231226000806 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245014232 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Primary |
| Provider Name | Samantha M Trapp |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487101523 PECOS PAC ID: 3072963578 Enrollment ID: I20231226000904 |
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