Healthcare Provider Details

I. General information

NPI: 1669920344
Provider Name (Legal Business Name): FLOURISH CENTER FOR CULTIVATING HUMAN POTENTIAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 09/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 E MICHIGAN AVE STE 214
JACKSON MI
49202-3765
US

IV. Provider business mailing address

2301 E MICHIGAN AVE STE 214
JACKSON MI
49202-3765
US

V. Phone/Fax

Practice location:
  • Phone: 517-745-8682
  • Fax: 517-513-6536
Mailing address:
  • Phone: 517-745-8682
  • Fax: 517-513-6536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801097448
License Number StateMI

VIII. Authorized Official

Name: MRS. KORAH HOFFMAN
Title or Position: FOUNDER/CEO
Credential: LMSW, MPA
Phone: 517-745-8682