Healthcare Provider Details

I. General information

NPI: 1225967128
Provider Name (Legal Business Name): TWO DOVES WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2026
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36340 UNION LAKE RD APT 201
HARRISON TOWNSHIP MI
48045-6630
US

IV. Provider business mailing address

2222 W GRAND RIVER AVE STE A
OKEMOS MI
48864-1604
US

V. Phone/Fax

Practice location:
  • Phone: 251-648-1944
  • Fax:
Mailing address:
  • Phone: 251-648-1944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. AUDREY R GALLAS
Title or Position: OWNER
Credential: LCSW
Phone: 251-648-1944