Organization
PROMINENT LIFE CHANGES THERAPY GROUP. P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WENDY VAUGHTER LLMSW (CLINICAL SOCIAL WORKER)
(586) 942-1430
Entity
Organization
Contact information
Practice address
2844 LIVERNOIS ROAD, UNIT 1434, TROY, MI 48099
(586) 942-1430
Mailing address
PO BOX 1434, TROY, MI 48099
(586) 942-1430
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1417419318
—
MI
Enumeration date
12/16/2021
Last updated
02/26/2024
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