Organization
LIFE WATER SUPPORT SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM LATEASE BISHOPJOHNSON MA, LPC (DIRECTOR)
(734) 589-1143
Entity
Organization
Contact information
Practice address
23800 W 10 MILE RD STE 150, SOUTHFIELD, MI 48033-3123
(248) 327-6593
(248) 996-8903
Mailing address
23999 W 10 MILE RD # 220, SOUTHFIELD, MI 48033-3158
(248) 327-6593
(248) 996-8903
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
09/16/2015
Last updated
08/12/2026
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