Organization
HOLISTIC DRAMA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENELLE MAZARIS LMFT (CLINICAL DIRECTOR)
(734) 748-3140
Entity
Organization
Contact information
Practice address
340 N MAIN ST STE 201, PLYMOUTH, MI 48170-1290
(734) 748-3140
Mailing address
15535 NORTHVILLE FOREST DR APT 251U, PLYMOUTH, MI 48170-4947
(734) 748-3307
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
4101006577
MI
Other
Enumeration date
03/23/2018
Last updated
03/23/2018
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