Organization
WITH MOM IN MIND,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE MARIE CARTER NDTR,CDM,CFPP, CPT (REGISTERED DIETETIC TECHNICIAN)
(313) 492-8446
Entity
Organization
Contact information
Practice address
18501 WEST MILE ROAD, SOUTHFIELD, MI 48075
(313) 492-8446
(248) 200-7968
Mailing address
18501 WEST MILE ROAD, SOUTHFIELD, MI 48075
(313) 492-8446
(248) 200-7968
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
251T00000X
PACE Provider Organization
—
—
261QA0005X
Ambulatory Family Planning Facility
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QP0904X
Federal Public Health Clinic/Center
Primary
—
—
261QP0905X
State or Local Public Health Clinic/Center
—
—
302R00000X
Health Maintenance Organization
—
—
Other
Enumeration date
12/21/2017
Last updated
12/21/2017
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