Healthcare Provider Details

I. General information

NPI: 1528936358
Provider Name (Legal Business Name): AVORTEX WELLNESS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2025
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 SHELBY ST STE 796
DETROIT MI
48226-3268
US

IV. Provider business mailing address

607 SHELBY ST STE 700
DETROIT MI
48226-3282
US

V. Phone/Fax

Practice location:
  • Phone: 248-846-1498
  • Fax: 248-846-1506
Mailing address:
  • Phone: 248-846-1498
  • Fax: 248-846-1506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name: MS. LATONYA RENAE MCCOY
Title or Position: CEO
Credential: LMSW
Phone: 248-846-1498