Provider Demographics
NPI:1073254389
Name:REIMAGINE TELEHEALTH COUNSELING AND CONSULTING SERVICES
Entity Type:Organization
Organization Name:REIMAGINE TELEHEALTH COUNSELING AND CONSULTING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KOASTER
Authorized Official - Middle Name:UVETTE
Authorized Official - Last Name:BRIM
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LMSW
Authorized Official - Phone:810-655-3867
Mailing Address - Street 1:2500 S. LINDEN RD
Mailing Address - Street 2:P.O.BOX 320115
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-9998
Mailing Address - Country:US
Mailing Address - Phone:810-655-3867
Mailing Address - Fax:
Practice Address - Street 1:2500 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-7074
Practice Address - Country:US
Practice Address - Phone:810-655-3867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-02
Last Update Date:2022-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty