Provider Demographics
NPI:1366124265
Name:ROAM WELL, LLC
Entity type:Organization
Organization Name:ROAM WELL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MIDDLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, NCC
Authorized Official - Phone:248-266-5616
Mailing Address - Street 1:1320 N CAMPBELL RD STE 22
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-1555
Mailing Address - Country:US
Mailing Address - Phone:248-266-5616
Mailing Address - Fax:219-200-3367
Practice Address - Street 1:1320 N CAMPBELL RD STE 22
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-1555
Practice Address - Country:US
Practice Address - Phone:248-266-5616
Practice Address - Fax:219-200-3367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty