| Willow Of Wonder Child & Family Therapy Pllc | |
|
35218 23 Mile Rd New Baltimore MI 48047-3650 | |
| (586) 291-1899 | |
| Not Available |
| Full Name | Willow Of Wonder Child & Family Therapy Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 35218 23 Mile Rd, New Baltimore, Michigan |
| Authorized Official Name and Position | Rebecca Konarz (DIRECTOR) |
| Authorized Official Contact | 5862911899 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Willow Of Wonder Child & Family Therapy Pllc 35587 Brooke Ct New Baltimore MI 48047-1137 Ph: (586) 291-1899 | Willow Of Wonder Child & Family Therapy Pllc 35218 23 Mile Rd New Baltimore MI 48047-3650 Ph: (586) 291-1899 |
| NPI Number | 1780107706 |
|---|---|
| Provider Enumeration Date | 07/21/2017 |
| Last Update Date | 04/22/2024 |
| Certification Date | 04/22/2024 |
| Medicare PECOS PAC ID | 2860754439 |
|---|---|
| Medicare Enrollment ID | O20180319001597 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780107706 | NPI | - | NPPES |
| CVO138370 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 6801083801 (Michigan) | Primary |
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