Provider Demographics
NPI:1235921685
Name:SAM TOTAL WELLNESS SOLUTIONS, LLC.
Entity type:Organization
Organization Name:SAM TOTAL WELLNESS SOLUTIONS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:NEKISHA
Authorized Official - Middle Name:AURELIA
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DNP,PMHNP-BC,FNP-C
Authorized Official - Phone:313-743-3126
Mailing Address - Street 1:20141 JAMES COUZENS
Mailing Address - Street 2:STE 6
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-1898
Mailing Address - Country:US
Mailing Address - Phone:313-743-2126
Mailing Address - Fax:
Practice Address - Street 1:20141 JAMES COUZENS
Practice Address - Street 2:STE 6
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-1898
Practice Address - Country:US
Practice Address - Phone:313-743-2126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty