Inner Man Wellness and Support Services

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

INNER MAN WELLNESS AND SUPPORT SERVICES

Practice address

4890 Ballantrae Rd
Bloomfield, MI 48301-1000

Phone

(248) 802-2712

NPI assigned

Mar 21, 2019

Last updated

Mar 21, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Roderick GillisonNPI 1205576832

Title

Executive Director

Phone

(248) 802-2712

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Roderick Gillison

  • Addiction (Substance Use Disorder) Counselor
  • Southgate, MI
  • NPI 1205576832
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1553126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553126400000",
    "number": "1669932109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4890 BALLANTRAE RD",
            "city": "BLOOMFIELD",
            "state": "MI",
            "postal_code": "483011000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4890 BALLANTRAE RD",
            "city": "BLOOMFIELD",
            "state": "MI",
            "postal_code": "483011000",
            "telephone_number": "248-802-2712"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNER MAN WELLNESS AND SUPPORT SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-21",
        "last_updated": "2019-03-21",
        "status": "A",
        "authorized_official_last_name": "GILLISON",
        "authorized_official_first_name": "RODERICK",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "248-802-2712"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Miriam Halprin, LMSW
• Danielle Harfoot, PA-C
• Daniel Herman, DC
• Joy Hopson
• Mohammed Ibrahim, PHARM.D
• International Medical Clinic PLLC
• James S. Brooks, MD, PLLC
• Joyful Journey's Living and Care LCC
• Kayla Kane, FNP-C
• Ramesh Chandra Kilaru, M.D

• Substance Abuse Rehabilitation Facility in Bloomfield, MI
• Providers in Bloomfield, MI by specialty
• Substance Abuse Rehabilitation Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.