Healthcare Provider Details

I. General information

NPI: 1275885881
Provider Name (Legal Business Name): A HEALING PLACE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2012
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 1ST ST
JACKSON MI
49201-2102
US

IV. Provider business mailing address

207 1ST ST.
JACKSON MI
49201
US

V. Phone/Fax

Practice location:
  • Phone: 517-425-4547
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number6301010931
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301010931
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301010931
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801090038
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801090474
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801090038
License Number StateMI
# 7
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801090474
License Number StateMI
# 8
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301010931
License Number StateMI

VIII. Authorized Official

Name: RACHEL FLOWERS
Title or Position: C.F.O./OWNER
Credential: LMSW
Phone: 517-425-4547