Healthcare Provider Details

I. General information

NPI: 1720925696
Provider Name (Legal Business Name): REGULATED MIND AND WELLNESS STAFFING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 E LINCON AVE
IONIA MI
48846
US

IV. Provider business mailing address

17177 N LAUREL PARK DR STE 439
LIVONIA MI
48152-3938
US

V. Phone/Fax

Practice location:
  • Phone: 616-727-0496
  • Fax:
Mailing address:
  • Phone: 734-462-0340
  • Fax: 734-462-0344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: RACHELLE WILLIAMS
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 734-245-7822