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Organization

GROW YOUR MIND THERAPY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
STEPHANIE LAKE LMSW (SOCIAL WORK/THERAPIST)
(313) 608-5544
Entity
Organization

Contact information

Practice address
1 PARKLANE BLVD STE 1200E, DEARBORN, MI 48126-4244
(313) 608-5544
Mailing address
23131 MICHIGAN AVE # 1168, DEARBORN, MI 48124-2020
(313) 608-5544

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary

Other

Enumeration date
10/10/2022
Last updated
01/28/2023
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