# HEART SPACE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538368139
- **Authorized official:** MS. MARIA PIA ROSA LINSALATA LMSW SCSW (OWNER)
- **Authorized official phone:** (248) 894-4573

## Contact information

- **Practice address:** 940 W CLARKSTON RD, LAKE ORION, MI 48362-2575
- **Practice address phone:** (248) 894-4573
- **Practice address fax:** (248) 690-7030
- **Mailing address:** 940 W CLARKSTON RD, LAKE ORION, MI 48362-2575
- **Mailing address phone:** (248) 894-4573
- **Mailing address fax:** (248) 690-7030

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | 6801079215 | MI | Yes |
| 1041C0700X | Clinical Social Worker | 6801079215 | MI | — |
| 106H00000X | Marriage & Family Therapist | 6801079215 | MI | — |

## Other

- **Enumeration date:** 07/13/2007
- **Last updated:** 07/17/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 8008987610 | BCBS | MI |