Provider Demographics
NPI:1750735197
Name:MI HEALING SPACE
Entity type:Organization
Organization Name:MI HEALING SPACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMSW
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-862-2197
Mailing Address - Street 1:601 ABBOT RD
Mailing Address - Street 2:STE 103
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-3366
Mailing Address - Country:US
Mailing Address - Phone:517-574-4197
Mailing Address - Fax:517-574-4201
Practice Address - Street 1:601 ABBOT RD
Practice Address - Street 2:STE 103
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-3366
Practice Address - Country:US
Practice Address - Phone:517-574-4197
Practice Address - Fax:517-574-4201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-22
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801095863104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty