Healthcare Provider Details

I. General information

NPI: 1821988361
Provider Name (Legal Business Name): THE RECOVERY LAB PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 WASHTENAW AVE STE 508
ANN ARBOR MI
48108-3401
US

IV. Provider business mailing address

4860 WASHTENAW AVE STE 508
ANN ARBOR MI
48108-3401
US

V. Phone/Fax

Practice location:
  • Phone: 313-800-2497
  • Fax:
Mailing address:
  • Phone: 313-800-2497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. THIERA DANYAL CLIFFORD
Title or Position: CEO
Credential: LP, LPC
Phone: 313-800-2497