Organization
NEBULOUS AWAKENING, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER ISHAQ MA, LLP (OWNER)
(248) 749-0029
Entity
Organization
Contact information
Practice address
100 W BIG BEAVER RD STE 200, TROY, MI 48084-5283
(248) 266-5942
Mailing address
100 W BIG BEAVER RD STE 200, TROY, MI 48084-5283
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
07/09/2024
Last updated
07/09/2024
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