Healthcare Provider Details

I. General information

NPI: 1073406252
Provider Name (Legal Business Name): WHOLENESS RECOVERED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 EAST ST
HOLLY MI
48442-1739
US

IV. Provider business mailing address

322 EAST ST
HOLLY MI
48442-1739
US

V. Phone/Fax

Practice location:
  • Phone: 248-891-3245
  • Fax:
Mailing address:
  • Phone: 248-891-3245
  • 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: DEVON JOHN ROACH
Title or Position: OWNER
Credential: LMSW
Phone: 248-891-3245